HomeMy WebLinkAboutMortgage_Sealea� "� 4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�� FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
°. J Stata Fortn 43709 (R6 / 506)
PreSaibed by Department of Local Gwemment Finance ��
�� �
INSTRUCTIONS: MAR i, ,�����
To be filed in person o� by mail with the County Auditor o/ the county where the property is located.
Filing Dates: 1) Real Property: Dunng the 12 monfhs before June Il o! fhe year the deduction is to be effec6ve. y
2) Mobile Homes assessed under IC 6-1. iJ: Be[ween January 15 and March 2 of the year�the���tlon� to be e8ective.
See reverse side fo�addftional insfiuctions and quaf�cations. GIBSON COUNTY AUDITOR
(owner or cont2ct buyer - see i
m7"/I PvY/ i. �i / q—
Taxing
reve�se side)
Key number / legal
��o� -Q7� J`—O -� Page number � G�
a - o
Assessed value of real property as of MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owner? � Yes � 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 difierent than that of applicant, indicate below: Is the property in question:
mortgagee or contract seller
Address of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What T�
counry in Indiana?
2o P I Zo
Signature
I i We
couNrrAUOn
amount of:
� a 20 � Zo
P �II P
Counry Auditor
❑ Real Property � Mobile Home (IC &1.
-����tdct? I Has this deduction been requested on
- oroperty for current year? ❑ Yes❑ No
SER.DE � AnrtNoN � �
�1 F y
zo °��SBa�
Date
ie penalty of perjury that the above and foregoing infortnation is We and correct and that the applicants was /were
and owner of the aforementioned property on March 1, 20
Person authorized by
or by IC 6-1.1-12-.07
Full residgFCaddress of applicant �Address ot authonzed person