HomeMy WebLinkAboutMortgage_Deputy (2)� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
F FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�. u/ State Fortn 43709 (RS / 4-03j
� Prescnbed by Depanment ot Local Govemment Finance �� .
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INSTRUCTIONS: Mark
To 6e filed in person or by mail with the County Auditor of the county whe2 the property is Iocated.0 C T 1 7 Z���
Filing Dates: 1J Real Property: During the 12 mon[hs belore May 11 o/the year fhe deduction is,to be elfectiven
2) Mobile Homes assessed under IC 6-1.1-7: Befween January 15 and Ma�ch the year the deduction }'�to�� e/fective.
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See reverse side for additional instructions and qualifications. GIBSON 0 NT Y AUDiTOFi I
contract buver - see
Taxing District "
(�'�, Q�� .
Assessed value of real property as of
March t, curtent year
If no, what is his / her exact share of
If name on record is diHerent
of mortgagee or contract
on raverse
Key number / legal
Record
%�� _ � /����(� Pagenumber
�
MoAgage / Contract indebtedness unpaid as of Is the ap�
March 1, wrrent year owner?
Address of mortgagee or contract seller (number and
Name of assignee or other owner or
Address of assignee
below:
�
S ///
t the sole legal or
❑ Yes ❑ No
owned with someone other than spouse, indicate with whom.
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city, state, ZIP
Is the property in question:
❑ Real Property ❑ Mobile Home (IC E1.1-7)
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. � -
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�ode� Dra`�er rI
Does applicant own property in any other If yes, what county? What Taxiny NQ. ••"' ���� =d on
counry in Indiana? CaYd �,❑ No
Deduction approved in the amount of:
20 �_ I 20 �
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Signature
COUNTY AUDITOR
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County Auditor
20 0 ii 20 � y 20
� p
Date
We certify under the penalry of perjury that Ihe above and foregoing infortnation is true and cortect and that the applicants was / were
��sident of Indiana and owner of the aforemeniioned property on March 1, 20
Person aulhotized by duly executed Power of Attomey
or by IC 6-t.t-12-.07
resident address of applicant ' U Address of authonzed person
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