HomeMy WebLinkAboutMortgage_Crooks MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
Si.•�f'- '' FOR DEDUCTION FROM ASSESSED VALUATION
- " "` Stab Forth 43709(R13/10-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: J I L AAA�/r , File Mark
To be filed in person or by mail. 11 IL Fonn filed with:
Filing Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the County Auditor or County RecordAtieg tlla Kcal here the properly is . unty Auditor
located on or before January 5 of the immediately succeeding calendar year. u ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before Ma 1 of h uction is sought
See reverse side for additional instruction and qualifications. r
Appllam(ownerorcontract.-ye - 7. , t -verse side) , GIBSON COU I Y AUDITOR
/ / SO '
T t Key it_ /legal description Record number Page number
c96-/y -17- 300-co/ •630)-bolo /6 3 3Yo
Assessed value of real property as of Mortgage/ indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole •
assessment date current year assessnxmt�ntyeh^ date of application legal or equitable owner?
OOrc1t ��..��o • ❑ Yes ❑ No
If no.what is his I her exact share of interest? If owned with someone other than spouse;indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
❑Real Property ❑ Annually Assessed
Mobile Home(IC 61.1-7)
Name of mortgagee or contract seller
`/ ' An_L ail ik,dr Oil
Address of mortgagee or contact seller(number an,sheet city,state,and ZIP code) - -
Name of assignee or other owner or holder of mortgage
Drawer 1�r
Address of assignee(number and street dry;state,and ZIP code) O.'''•••••., 1/�
Does applicant own property in any If es,what Doan What Taxis District? I Ca 1-� 1N 3 `� dion
other county Y county? 9 _ O. ...,3.... ....
in Indiana? ❑Yes ❑No w.._
11 •..
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or conbaci.,...,._-- a county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the oeuu.........
COUNTY AUDITOR
Deduction approved in the amount of.
20 20 20 20 d20 20 20
Signature o Nx / d �� Counry/�% /Y A_ Date(month, aye
xi aaLf/I/L'.br 'C/G_n�/cone(nJ�. si ��l
I We certify under the penalty of perjury that the above and foregoing information is true and corned and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
nature( hint name ..J Date(month,day,year)
Fuil resident address of applicant(number and street city,state,and ZIP code)
CO lzzi6) E no S OAk/qtr! /',fy, 1 A '/7660
Person authorized by duly executed Power of Attorney or by IC 61.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. .