HomeMy WebLinkAboutMortgage_Dunn (4) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
,� County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
f_ Stale Farm 43709(R13/10-15) .
Prescribed by Department of Local Government Finance � IT T V j,)
INSTRUCTIONS:
.I .L.i �J e Mark
To be filed in person or by mad. - Form f with:
Fifing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction isbt.1 2016 filed
Must be filed or postmarked with the CounlyAuddor or County Recorder of the county where the property is ❑ County Auditor ,
located on or before January 5 of the immediately succeeding calendar year. • County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the CorultyAud.• • 7t -•i
where the property is located during the twelve(12)months before March 31 of each year the....! �:gK4'iS
See reverse side for additional instructions and qualifications. GIBSON COUNTY • DITOR .
Apprira comer
or contract buyer-see resections on reverse
Taxing District
211-
Key number/legal desaiption Record number Page number
Drz�.-1.-e G.� rz(o - /4/-/P - ii o/- oov./'� 9.-00. 7 /(o .�i0'4/S
Assessed value aired P as of Mortgage/Contract indebtedness unpaid as of - Mortgage I Contract indebtedness unpaid as of Is the app6rant the sole
assessment data,current yea eveavtcait data,current year date of application legal or equttable miner?
9 9 2- ❑ Yes ❑ No
at
If no,wh S his/her exact share of interest? If mined with someo4 other than spouse,Indicate with whom
If name on record is different than that of applicant,indicate bebx t5 the Property N question:Annually Assessed
• ❑ Real Property ❑ Annuafy Assessed
Mobile Home(IC 61.1-7)
Name of mortgagee or contract seller
(n^ 21. I
Addr of mortgagee or contract sager see ((number numb/l and street,city,state,and ZIP code) O-
ess mortgagee Name of assignee or other owner or holder of mortgage '
Address of assignee(number and sheet rdry,state,and ZIP codel M -
Dees t own property in any If yes,what county all - Oµ1)U'& en requested If yes,state amount of deduction
in Indiana? ❑Yes ❑No (es(es 111 No
A person is not entitled to this deduction unless the I b- O l S act indebtedness that is recorded in the county '
recorder's office(including any home cutely fine of r ;is the basis for the deduction.
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County County Date(month,day,yea)
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/contract buyer of the aforementioned property on date application is filed.
KSignahue ru0 name�y �J Data(month,day,year)
A/ Full resident address of appfi ant(numb and sheet city,state,and ZIP code)
2-31 ,J et-c b p ."--as-r^ D etit~1 Y 7 !r !0 0
Person authorized by duly executed Power of Attorney or by IC 6-1.1.12-0.7 f Date(month,day,year)
Address of authored 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.