HomeMy WebLinkAboutMortgage_Vaughn Exr, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year l
`''° FOR DEDUCTION FROM ASSESSED VALUATION
State Forth 43709(R731 10.15)
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<i-isiii Prescited by Department of Local Government Finance
INSTRUCTIONS: FIIP�APt1�'%
To be filed in person or by mail It 1tLF'bar''mmirti :
Filing Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is so JJYII J l d
Must be filed or posbnarked with the County Auditor or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. (1�1C�((`` t County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the cDi nc 2 9 21 r
where the property is located during the Mete(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(ownibTact buyer-see on re •-side) ��
aA gr r k) GIBSON COUNTY AUDITOR•Taxing District ker/ i•-[' / Record number Page ny(nber
Assessed value of real property as of Mortgag-/Contract indebtedness unpaid as of Mortgage I Contract ind redness unpaid as of l Is the applicant the sole
assessment data,current year assessment
ci date,current year date of application legal or equitable owner?
❑ Yes ❑ No
If no,what is his I her exact share of bitterest? . Oy If owned with someone other than spouse,indicate with whom
If name on record is afferent than that of applicant,indicate belur. Is the property in question:Annually Assessed
❑Real Property ❑ Annually Assessed
/� Mobile Home(IC 6-1.1-7)
Name of mortgagee contrail seller / /
R • , ^ la .
Address of mortgagee or contract seller(number and bbeet city,state,and andGS IP code)
Name of assignee or other owner or holder of mortgage — - 1- n/�
Address of assignee(number and street,city,state,and ZIP U O 1, l Yt ///fl l/lppp n��., :. Q_
Does applicant own property in any If yes,what county? '^'v'-MU" 9I,/.*LJ-`^' , `/ requested If yes,state amount of deduction
other county U
in Indiana? ❑Yes ❑No ❑No
A person is not entitled to this deduction unless the pe �I_ — 5 ( q ( indebtedness that is recorded in the county
recorders office(including any home equity fine of ae HD `I I the basis for the deduction.
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Auditor County i Date(month,day,year)
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.
Signature( fu8 Data(month,day,year)
is -.)q- 1f-
F • t address applxant(number and street city,state,and ZIP code
1 a s Eo4 LA x, 47660
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)
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The penalties for perjuy can include imprisonment up to two and a half years and a fine not to exceed$10,000. .