HomeMy WebLinkAboutMortgage_Koenig aSTATEMENT FOR DEDU
OF CTION MORTFROM GAGE
ASS OR ESSED CONTRACT VALUATION INDEBTEDNESS Cou Township Year
q ' Pres Finn 4by09(par/ten a� -_
�— Prescribed by Department of Local Government France
1 Lit a
INSTRUCTIONS:
To be filed in person or by mail. •
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought ffff����1111
Must be hied or postmarked with the County Auditor or County Recorder of the county whem the propefW4s1 3,0 Z Fr County Auditor
boated on or before January 5 of the immediately succeeding calendar year. rc
2) Mobile I Manufactured Homes not assessed as Rea/Property:Must file with the County Auditor of the county County Recorder
where the properly is located during the twelve(12)months before March 31 of each year the deduction ': ., t -
See reverse side for additional instructions and qualifications. Nil'...i5I,n.P.A..
Apptiant(owner or contract buyer-
rsee - .i. t reverse side) GIBSON COUNTY AUDITOR
n
�T ¢fit Key number/legal description Crt-/^ // Record number �e number
ittince - �(a - la - O7 - 30/ my. 31S-oa- R ,)I 3o2 ,
value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment data,current year assessment date,=rent year date of application legal or equitable owner?
70? ycO ❑ Yes El No
If in what is his/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 bu4aw Is the property in question:Annually Assessed
❑ Real Property ❑ AnnuallyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgag pj contract seller
Address of mortgaaggee?or contact seller(number and street city,slate,and LP code)
Name of assignee or other owner or holder of mortgage n
Address of assignee(number and street city,state,and ZIP coo 1 ' r t:IT }I�) a - A~c m
Does applicant own property in any If yes,what county? l�0 6.),-) sted If yes,state amount of deduction
other county 11 a b ]No
in
other cou? ❑Yes El No ,/� _ J
A person is not entitled to this deduction unless the perso I I ` Stedness that is recorded in the county
recorder's office(including any home equity line of credit I asis for the deduction.
Deduction approved in the amount of
20_ 20 20_ 20 20 20 20
Signature of hwmty Auditor County 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 afore ntioned property on date application is filed.
X�$rgnature Date(month,day,year)' \ n 37703 O�ZO t,
F eM a of applicant( umber and ady,state,and ZIP 41 l
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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.