HomeMy WebLinkAboutMortgage_White (6) • .- STATEMENT OF MORTGAGE OR CONTRACT INDEBTE
FOR DEDUCTION FROM ASSESSED VALUATIONnI Township Year
'` 2 State aorrn 43705(S11/6-09) j 4 y /I
,.„. • Prescioed by Department of Local Government Fnanpe
INSTRUCTIONS MAR 2 8 2016 File Mark
To be filed in person or by mail. I Form filed with:
Aline Dates: 1) Real Property Must be completed and dated in the calendar year for which the ded - n is s oh
Must be filed with the County Auditor or County Recorder of the county where the p. ❑ County Auditor
on or before January 5 of the immediately succeeding calendar year. GIBSON COUNTY AUDITOR ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the
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• county where the property is located during the twelve(12)months before March 31 of each year the
deduction is sought.
See reverse side for additional instructions and qualifications. •
Appr
to(owner or contact buyer-.see;eitricSions on reverse side)
4-ti-ei I nr �, YCII kcks n °4 tepke.t\ 0 U)k)4e
-farina D¢[nC Key number/legal descnotionp+ sri 5b 3-c2-lo I. I5 _
2-/o-la-63 —gm-ODI ,3 Oa--/
AF=teed value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
Marc;1•=rent year Marrs 1,current year - date of aoorcation legal or eoui' die owner?
list Lo \f 10 W-Dl/ LI Yes ❑ No
If as,wrist is his/her exact share of interest? If owned with someone other than spouse,indict with whom
If tame on record is different than that of applicant,indicate below. Is the a fry in question:Annually Assessed
eal Property ❑Annually Assessed
Mobile Home(IC 5-1.1-7)
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Na.-4 mortgagee or tact seller
\---1 YS i- Dhr reSR`b1'a 5‘.0\r\9S }tiU
.Address of monoagee or contact seller(number anc sweet,city,sata'and ZIP ode)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,try,sate,and ZIP code) _
Do..s applicant own property in any other If yes,what nunry? I What Taring District? 'Ras this deduction been requested on property
runty in Indiana?
L I Yes No for current year?
❑ Yes ❑ No
COUNTY AUDITOR
Dedu�on approved in the amount of:
20 20 20 20 20 20 20
Sigramre of County.Auditor County y,we
Date(month,day,
I/We certify under the penalty• •erjury that the above and foregoing information is sue and tarred and that the applicant is a resident of Indiana and
owner conga o..e of the — entioned property on date application is filed.
Signature(• hers !I na e 1" _ Date(month,day,year)
lids. • l.. r _, s/l�✓ / d/_ ./ ..\ . -
r
Full r= ..e.,ad. - cot applicant(number and saeee!,city, ,°p'd LP- •e) 7
�t/ a �. C 1 5 T Yrf v�P2 Corr r...V lA l L¢riU
Pass,autnorized by duly executed Power of.Attorney of by IC 5-1.1-12-0.7 h pate(month,day,year)
Address of authorized person (number and street,city,state,and ZIP:ode)