HomeMy WebLinkAboutMortgage_Krieg (11) F '' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
"'_;_ FOR DEDUCTION FROM ASSESSED VALUATION
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�--" Prescribed by Department of Local Government Finance
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 nnn
Must be filed or pos marked with the County Auditor or County Recorder of the county where the properyrs 5 2 B County Auditor
located on or before January 5 of the immediately sucoeedng calendar year t3 ' County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before Mardi 31 of each year the deduction isrsought
See reverse -.: for additional instructions and qualifications. Sr • 1 �
AV nt�- 'rcon�ct restrictions n _` )(1" Q GIBSONCOlUNTTYAUDITOR
Taxin• � +�/- • Key / tlescription Record number Page number
/07 O � a9/. �d0 - l) d ao /8 aS6
-•value of real property as of Mortgage t Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment dale,current year assessnent date,current year date of legal or equitable owner?/ - 00 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than cpvica,indicate with whom
If name on record 5 different than that of appli ant,indicate below: Is properly in question:Annually Assessed
' . Real Property ❑ AnnuatyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller gtiovAienx /
Address of mortgagee or contact seller(number and street,city,state,and •cod-
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street dry,state,and ZIP code) �.T O I f�
Drawer NO ` U _
Does applicant own property in any If yes,what county? .What Taxing District? Has this
in lndcounty on prop l f Q
other Indiana? ❑Yes ❑No current prp. J�/
A person is not entitled to this deduction unless the person has a balance on the person's mortg, Card N�. —
recorders office(including any home equity line of credit that is recorded in the county recorder':
COUNTY AUDITOR
Deduction approved in the amount of.
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 I contract buyer of the aforementioned property on date application is fled.
nature((ow nor e) 131-11 Date(month,day,year)
% resident ad t(; and street,cry,state aandZZ1P code)
U t 004}1111-W' t nu l m 1 M'f'r'
Person authorized by duly executed Power of Attomey or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet city,state,and ZIP code)
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The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. -