HomeMy WebLinkAboutMortgage_Speicher�'�' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S � Siale Form 43709 (R4 / 70.01)
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� PrewibeG by Department ot Local Govemment Finance
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INSTRUCTIONS: � � � � �rk �i;
To be filed in person or by mail wifh the CountyAuditor ol the county whe2 the property is loc �� �
Filing Dafes: 1) Real PiopeRy: During the 12 months befo�e May 11 of the year the deduction i o be el(ective.
2) Mobile Homes assessed under IC 6-1.1-7: 8ehveen January 15 and March 31 of the �r��r�th�dgd� is to be elfective.
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Applicant (ownerorcontract r ee 2s c6 ns o vers side) / GIBSON CvOUNTV AUDI70R i
Taxing Distrid Key number egal description Record number
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Assessed value of real pro rty as of Mortgage / ontrad indebtedness unpaid as of Is the applicant the sole legal or equitabie
March 1, current year March 1 ���� a 3�j � ownef? ❑ Yes ❑ No
If no, what is his / her exad share of interesl? If owned with someone other than spouse, indicate with whom.
— G� 5`- 300 — /. 75� G0�
If name on record is different than that of applicani, indicate below: Is the property in queslion:
❑ Real Property ❑ M�le Home QC fr1.1-�
�me of moAgagee or contract seller
Address of mortgagee or conVad seller (number and sfreet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Dces applipnt own property in any other If yes, what county? What Taxing DistriIX? Has lhis deduction been requested on
county in Indiana? property for curcent yea(? 0 Yes � No
COUNTY AUDITOR
Deduclion approved in the amount f:
20 � 20 Q�_ ` 20 20 20 20 � 20 �
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Signature County Auditor Dale
/ We certify under the penalty of perjury that the above and foregoing infortnation is lrue and corred and thal ihe applicants was ! were
resideni of Indiana and owner of the aforemenlioned property on March 1, 20
Si e(o ers 11 name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
u I resident address of applipnt Address of authorized person
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