HomeMy WebLinkAboutMortgage_Aikman STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
- ' State Faun 4370 (R13 I 10.75)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mall. Earn tied 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 Recorder of the county where Me property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year.
❑ Court
2) Mobile/Manufactured Homes not assessed as Real Property.Must/de with the Courtly Auditor of the county County Recorder
where the property is located during the twelve(12)months before Mang 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(cnwnontract buyer-see
rej iuim5 011ifenne side) - .
d— K YYl Girt nk-c „Th
Taring District e, -
Key number/legal Record number Page n r
x6 - 13-a - .Ro0 - pot. 443 -b04 /7 a �
Assessed value dread property as of Mortgage/Contract culebdedness unpaid as of - Mortgage/Contract indebtedness unpaid as of Is the appfcanf the sole
assessment dab,aarerd year assessment date,aural year data of application legal or equdable owner?
/045150 ❑ yes ❑ No
If no,what is his I her exact share of interest? If cremediftect opinry indicate with whom
If name on record is differed than that of applicant,Indicate below. Is the property in question:Annually Assessed
/}�{ JUN 5 201/0 Real Property ❑ Mio tt-�
Name of mortgages or contract seller I s 3 ._23_44---
-
Address of mortgagee or contract semi(number and street,ray,slate,and ZIP code) -'h4gA CA
GIBSON COUNTY AUDITOR —
Name d assignee or other owner or holder of mortgage ' —- -
AS m R0 I )
Address of assignee(number and street,thy,state,and ZIP code) •
`y/ ((/f/-�7( /
Does applicant own property in any ayes.what county? - What Taxing District? Has / ��? �'`" / A ion
Indiana?other county in ❑Yes 0 N CUM .. 'n/ .23Q }
A person is not entdled to this deduction unless the person has a balance on the person's mo / — wnty '
recorder's office(including any home equity fine of credit that is recorded in the county record ---
-C.N�...
COUNTY AUDITOR • .i.. .
Deduction approved in the amount o1: _
20 20 ' 20 20 20 - 20 20
Signature of County 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/contract buyer of the aforementioned property on date application is filed.
S�napae(owner's e) �j / '.... . Date(month,day,year)
Full erd address of applicant(number and street city,state,and ZIP code) .
3 16 S.. X50 E. Fiowfcr Soo i1-A) 1764/9
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,aly,state,and ZIP code) -
The penalties for perjury can include imprisonment up to two and a half years and a One not to exceed S10,000. •