HomeMy WebLinkAboutMortgage_Stone s. . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
1._: .
' �,�:�`; FOR DEDUCTION FROM ASSESSED VALUATION
State Forth 43709 Department Presabed by Department of Local Government Finance
INSTRUCTIONS:
To be filed in person or by mail.
Filing Dates 1) Real Properly:Must be completed and dated in the calendar year for which We deduction is sought OCT 3 b led with
Must be Wed or postmarked with the County Auditor or County Recorder of the courtly where the property is it County Auditor
located on or before January 5 of the immediately succeeding calendar year. ■ . - Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor d�o�f the •. n ' .i
where the property is located
and during the ionA9(12)months before Marctt 31 o1earh year the GIBSON •UNTY AUDITOR
See reverse side for additional instructions and qualifications. G 16 J
t(owner or contract buyer- restrictions on reverJs��'/�le)
6J CG ✓ /17Dt4t'/v
Taxing District Key number/legal description Record number Page number
a( - /8 -o9 - zoo - 0o3. 7c4 - 0 -1-/ 1G asy
Assessed value q{ al property Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,anent year date of appli tit on legal or❑equitable
Yes ❑owner?
No
If no,what is his/her exact share of interest? If owned with someone oother��ne,indicate with whom
If name on record is different than that of applicant indicate belwr. Is the property in question:Annually Assessed
❑Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller T G C Le
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Ackirs of assignee(number and street,dty,state,and ZIP code)
T to N L —7 - 3 -// 9y 4 C
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
otter county ❑ p� ❑n Indiana? Yes ❑No current year? Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the 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 deduction.
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,yew)
I I We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
K Shg ,fuH 2� /T�-er Data(month,day,year)
ent address/f�' of applicant((nuuumbber and street city,state,And ZIP code)
5- 717174 u, SR/le' (.,,� //0 Dan 17( 766 _5-
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0. Date(month,day,year)
Address of authorized person (number and street city,slate,and ZIP code)
The penalties for perjury can include imprisonment up to Iwo and a half years and a fine not to exceed$10,000.