HomeMy WebLinkAboutMortgage_Dearing A '�, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
i ' -il FOR DEDUCTION FROM ASSESSED VALUATION
:7 State Finn43709(R131 f0.15) - r
-5•L "
Prescribed by Department of Local Government Finance F I ,j
INSTRUCTIONS: _
To be Filing Dates: 1) for Property:Must be completed and dated in the calendar year for which the deduction is sought. JUL 3 1 t tiled
Must be tiled or postmarked with the CourdyAUddor or County Recorder of the county where the property is ❑ County Auditor ,
located on or before January 5 of the immediately succeeding calendar year. 7
2) Mobile/Manufacbaed Homes not assessed as Real Property Must file with the County Auditor of, I .tt Recorder
where the property is located during the twelve(12)months before Mardi 31 of each year the dad -ffor•J�'ml'
See mversa side for additionalinstructions and qualifications. GIBSON CO NTY AUDITOR ,
t(miner or contract buyer-see restrictions on reverse side) ,
� ei
T ' District Key Record bomber Page number
.L -taw a4,_i9-/9- .3oo -cot. 636 -0 XS--- P.ol ay/ /
Assessed value rtmal wcperiy as of Mortgage I Contract-h,debtedness unpaid as of - Mortgage/Contract indebtedness unpaid as of is the applicant the sole
m,eaaunnd data.amen year assassnent date,amend year date of application legal or equitable owner?
/C Q Q 0 Q ❑ Yes ❑ No
If no,WW's his I her exact share of interest? gowned waft someone other toff spouse,inebriate with whom
if name on word is different than that of applicant,indnate below: 1 Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Horne(tC 61.1-7)
Name of mortgagee or contract seller a t - 120 a± . - —
Address of mortgagee or contact seller(number and street,city,state,and ZIP code) •
• Orawei' 1N.O _
Name of assignee or other owner or holder of i,antuage ' •'" ••.,,r• '•
Ca IA nlo. ....,a
Mpress of assignee(number and street cdy,state.and ZIP code)
f 5 AD SL,-) / 9 - 3 -10 . `75' A- c—
Does applicant own property in any If yes.what county? . What Taxing District? Has this deduction been regw=.o..
other in Indiana? ❑Yes ❑No - add'
mentyear? ['Yes ID 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 awry fine of credit that is recorded in the county recorders office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount ot:
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 • property on date application is filed.
` Sgnatpa,(mvner's tuff name) ('` ' Date(month,day,year)
; �
lc -catt'—1 C
` rfiii resident address of 4pii ant(number and street, - , ate,and ZIP code
A 2 So s Sw� ;, % 7ti5‘8
Perrson authorized by dirty executed Power of Attorney or y IC 6 .1- 2-0. / Date(month,day,year)
Address of authorized person (number and street eTy,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.