HomeMy WebLinkAboutMortgage_Pickens (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ' County Township Year -
' FOR DEDUCTION FROM ASSESSED VALUATION 1
'i'0 State Forth 43709(R13/10-15) 20 9
�,, SO � .SOrI 1
Prescribed by Department of Local
where the property is t1 County Auditor
located on or before January 5 of the immediately succeeding calendar year. ill 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.
Approant(o her or corktact buyer-see ctions on reverse side)
1 waA(Te is kerts .
Taxing D ict V Key numbe liege!description Record nu be Page numbe
*1 �(- 0 7 description_ nOl - 6 -OZLI Zd\ 1-1 K .
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage!Contract indebtedness geld as of Is the applica the sole
assessmentdate,current year assessment date,current year date of a li tion • legal or equ' le owner?
15� o(�t I --- Yes ❑ No
If no,what is his I her exact share of interest? If owned with sore eone other than spouse,indicate with whom
if name on record is different than that of applicant,indicate below: Is th roperty in question:Annually Assessed
Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract ieller . 3-4, ,
Address of mortgagee or contract seller(number and street city,state,and ZiP code /7 n�K I '. jO$ 822L
Name of assignee or other owner or holder of mortgage l '��, I�
Address of assignee(number and street,city, d a P cod Is / 9— 44 8
Does applicant own property in any If yes.what county? What Taxing C yes,state amount of deduction
inIndiaa? ❑Yes 0 No [IEC 1 0 2119
A person is not entitled to this deduction unless the person has a balance r,,,..,Q r,,,,,,,,,,,,,.._..,_-__. _-______ _ :that is recorded in the county
recorder's office(including any home equity ling,of credit that is reco din the county recorder's office)that is the basis for the deduction.
�.1 UJI�i COUNTY AUDITOR
Deduction approved in the amount of: GIBSON COUNTY AUDITOR
20 20 20 20 20 ' 20' 20
Signatu I ,? ourkty uditor crsq. County , Date(month,day,year)
\ \--v, 9
,Non
I, -certify under the pe' ; 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.
Signature(owner's name) Date(month,day,year)
Full resident address appli t(number and t city state,and ZIP code)
I Sao E fscln,,Jt�o In t �Yl— L.1�- 6 3�' •
Person authorized by duly executed Power of Attorney orby iC 1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
The nanalties fornerium ran include imndsonmant un to two and a half years and a line not to exceed S10.000_