HomeMy WebLinkAboutMortgage_McGillem --
e STATEMENT OF MORTGAGE OR CONTCT
.:# FOR DEDUCTION FROM ASSESSED VALUATION INDEBTEDNESS County Township Year
�• Slate Fonn 43709(R13/1415) �1'b� Wl�
Prescribed by Department of Local Government Finance YetSCO1 • 1 1INSTRUCTIONS: File Mark
lb be filed in person or by mail. Form filed 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 the property is County Auditor
located on or before January 5 of the immediately succeeding calendar year. 0 County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
wham the properly is located during the twelve(12)months before March 31 of each year the deducion is sought
See reverse side for additional instructions and qualifications.
t( or contract buyer- on reverse side)
lie,-, C f_ .-1XeStrI .
Tann�¢�p lf)Cev number/legal d ton Record number Page number
Y C►�N,. Il .4- �2-i\ - -2p\ 6o I - qk,r-0Z3- tot 3Z
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applica the sole
assessment date,aurent year assessment date,current year date of appJJJ���///p� ^ MCP legal or equitable owner?
ago� ' �] Yes ❑ No
If no,what is his/her exact share of interest? If owned with sour ne spouse,indicate with whom /\
b name on record is different than that of applicant,indicate below. I property in question:Annually Assessed
Real Property 0 AnnuallyAssessed
Mobilebfe Home(IC 6-1.1-7)
Name of mortgages or contract seller O`A NE0 Sank-
1`k- -— —
Address of mortgagee or contract seller(number and alhet city,state,and ZIP code) `_y3-0/ O — / lk 3 a
•
Name of assignee or other owner or holder of 9 .
Drawer NO
Address of assignee(number an tree
Does applicant own property in any i t 9 What Taxing District? F... Card N 0. •
bon --
m�Indiana?county ❑Yes El No aurent year? LI Yes LJ No I
A person is not entitled to this ded unle the n-/ras a balance on the person's morlyeyu or contract indebtedness that is recorded in the county
recorder's office(including any horn' it that is recorded in the county recorder's office)that is the basis for the deduaton.
GIBSON COUNTY AUDITOR COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 ' 20' 20
Signature of County Auditor County Date(month,day,year)
S\reLM £mill /�CT4 Gibson - 4 .16. l9 .
1/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 fled.
XSw�,y�(I/wre(owners full name) '7`'I/(1I I`r11�n Date(month,day,year)
` Full 2ai item fxant(nulnberantl �tstate,and ZIP code) LI •16. 1 q
8b& S llgre Si- 0yN - - L13C o ,
Person authorized by duly executed bower 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.