HomeMy WebLinkAboutMortgage_Davis (25)ie y STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'i��'r FOR DEDUCTION FROM ASSESSED VALUATION . . Coun Township Year
w� / S�ate Fortn 43709 (R6 / SO6)
� Presaibed by Oepartment of Local Govemment Finance
INSTRUCTIONS: il M�
To be fi/ed in pe�son or by mail with the County Auditor o( lhe county where the property is locat
Filing Dates: 1) Real Property: Dunng the 12 months be(ore June if of the year the deduction i�e�
2J Mobile Homes assessed under IC 6-L 1-7: Between January 15 and Maroh 2 of the year the deduction ' to be eflective.
See reverse srde fo� additional instiuctions and qual�cations. �QN 1 0 Z��
�
Appiicant (owneror ntrac buyer- see restri � s on 2verse side) GIBSON COUNTY AUDITOR
Taxing Distrid Key number / legal description : Re rd number
a�o s a �a9
03� 71 L.�s-aoG �rr /• $ 7d.a, P
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of . Is lhe ppli e sole legal or equitable
March 1, wrrent year March 1, current year owneR es � No '
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that af applicant, indicate below: Is th operty in queslion:
1 Prop�ty ❑ Mobile Home (IC 61.1-�
��ne of mortgagee or contrad seller
i . .
Address of mortgagee or contrad seller (number and st2et, city, state, ZIP ._ _
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand st2et, city; sfate, ZIP code) '
Does applicant own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
county in Indiana? property for cunent yeaf? � Yes❑ No
COUNTY AUDITOR
Deduction approved in the amounf of:
20 � 20 � 20 � 20 20 20 20
OI �
Signature � County Auditor Date
•We certify under the penalty of perjury lhat the above and foregoing information is true and corred and that the applicants was / were
esidenl of Indiana and owner of the aforemenlioned property on March 1, 20
ignature (owne/s full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12.07
Full resident address of applicant Address of authorized person
I�� rnv a S e r� �-C (� � � I 3