HomeMy WebLinkAboutMortgage_Mileyi��� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
��FOR DEDUCTION FROM ASSESSED VALUATION
' State Fortn 43709 (R6 / SO6) '
Rwaibed by Department of Loral Gwemment Finaxe
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INSTRUCTIONS: File Mark
To be (led in pe�son or by mail wdh the County Auditor of the county where the propeRy is located. FEB 4 ZQQB
Filing Dates: i) Real Property: Dunng the 12 months 6efoie ,lune �1 0/ the year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-L 1-7: Between January 15 and March 2 o/the ye�e dedttc� is to be effective.
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See reverse side fo� additional instructions and qualificaG�ons.
GIBSON COUNTY AUDI70R
Applicant �ner or contracf buyer -
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reverse side) � ,
number / legal
Record number
Page number
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole fegal or equitable
March 1, current year March 1, current year y Q � y 3,q � ownef? ❑ Yes � No
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If no, what is his / her exact share of interesi? If own with someone other than spouse, indicate with whom.
If name on record is difterent than that of applicant, indicate below: Is the properiy in question:
mortgagee or conVact seller
Address of mortgagee or contrad seller (number and
Name of assignee or other owner or holder ot mortgage
Address of assignee (num6er and st2et,
Does applicant own property in any other If ve� W�-• ;ounty?
county in Indian��
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Card NO. . . v......... 1
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Signature
❑ Real Prope�iy ❑ Mobile Home pC fr1.1-�
state, ZIP
What Taxing Distrid? Has this dedudion been requested on
property for current year? � Yes ❑ No
COUNTY AUDITOR
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Auditor
20
20
20
certify under the penalty of perjury that the above and foregoing information is lrue and corced and that lhe applicants was / were
lent of Indiana and owner of the aforemenlioned property on March 1, 20
� Sign e (owi
�Full resident a�
ss�y�
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Person authorized by duly executed Power
or by IC 6-1.1-12-.07
person