HomeMy WebLinkAboutMortgage_Bogan�'��STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
���' • Slate Form 43709 (R6 f 5-06)
� Presaibed by Department of loral Gwemment Finance
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INSTRUCTIONS: File Maric
To be filed in person or by mail with the County Auditor o/ the county whe�e the property is located. � U N �$ 2��] ��
Filing Dates: 1) Real Property: During the 12 months before June Il of the year the deduction is to be eflective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the-deduction.is to be eRective.
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See reverse side !o� additional instructions and quali�cations. �
GIBSON COUNTY AUDIg6R
orcont �tbyyer-s� res�ctioi�
.,,, / 1
Taxing
Assessed value of real
March t, curtent year
as ot
no, what is his / her exacl share of interest?
Key number / legal
Record number
Page number
Mortgage / Contrad indebtedness unpaid as of I Is the applicanl the sole legal or
March 1, cunent year �$ � d� � ownef? ❑ Yes ❑ No
�// _ , /_ aPi
If name on record is diiferent than that of applicanl, indicate below:
�me of mortgagee or contrad seller _ n n/ �
.(� /// -
( y (J-�E
Address of mortgagee or conVact seller (number and s et, city, s
Name of assignee or other owrSer or holder of mortgage
Address.of
Does appli�
county in li
Deductior
20 �
P
Signature
(numberand street, city, state, ZIP code)
,?
1)I":l{YCI'i�r�.��� /�Q�
If owned with someone other ihan spouse, indicate with whom.
What Taxing Distrid?
C81-<j i\'� �� :OUNTY AUDITOR
� 20 �� 20 0 i- 20 � 20
Q � 1 I�'
County Auditor
Is the property in queslion:
❑ Real Properly ❑ Mobile Home pC 61.
Has this dedudion been requested on
property for wrrent yeaf? � Yes� No
�
Date
20
certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned propeAy on March 1, 20
full
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07 -
resident address of applicant v , �Address of authorized person