HomeMy WebLinkAboutMortgage_Edwards (2) .T , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
' ' � FOR DEDUCTION FROM ASSESSED VALUATION
l State Fort 43709(R13/10-15)
�,�, Prescribed by Department of Local Government Finance ` 0` � j3 aft A.
File Mark
INSTRUCTIONS:
To be filed in person or by mail. Form ed with:
Filing Dates: 1) Real Properly: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. ❑ 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 March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Ap--1 (owner or cor
ct uyer see b� lions pn �e)
S(ea w n ll___ CAI
Taxing District Key number/legal description Record number Page number
2- - OY 1 I -2o o-oo0 23e1-(72.3- -zOkg 42--31
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/ n indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of ! v
opD� legal or table owner?
Yes ❑ No
If no,what is his/her exact share of interest? If owned with som e other thtin spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is property in question:Annually Assessed
eal Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee F 1 I/...)Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage OCT 16 O
19
Address of assignee(number and street,city,state,and ZiP code) )064c jet
GIBSON COUNTY AUDITOR
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? Yes 0 No current year?
El ❑Yes ❑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 equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount ot.
20 20 20 20 20 ' 20' 20
e
Signature of County Auditor �� County \�� Date(\�,
I
I/We certify under the pena ty of perjury that the above and foregoing information is and correct and that the applicant is a res' nt of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Si/lure( - s full name) ........„0,. Date day, p '
•
F residen d f and of ap nt(n s t,city,state, d Z cod I
Person authorized by duly executed Power of Attorney or I 6-1.1-12-0.71 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
Tha nanallias fnr nariuni ran innInda imnricnnmant fin M tun an`I a half vaarc anti a firm not to nrronil 4411 Mil