HomeMy WebLinkAboutMortgage_Hall�/:i n� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
� Slate Form 43709 (R6 / 5-06)
• �«.
Presoibed by �eparUnent of Lool Gwemmeni Finarice
INSTRUCTIONS:
To be filed in pe�son or by mail with the County Audito� of the county where the property is located. � 2
Filing Dates: 1) Real P�operty: During the 12 months before June i l o/ the year the deduction is to be eflecii've 1 9 Q��
2) Mobile Homes assessed under IC 6-7.7-7: Between January 15 and Ma�ch 2 of the year th�e drreduction is to 6e elfective.
See reverse side for additional insfiuctions and qualifications. v'(� '��
GIBSON COUNTY AUDITOR
see rest s on reverse
4�- l�ti a c �
Taxing District
C,O���
Assessed value of real property as of
March 1, current year
If no, what is his / her exad share of interest?
If name on record is different than that
mortgagee or contrad
Key number / legal d"escription Record number
�v-0s:3s -Yoo-000,vz8-oo� D
/y.�a '���— � Page number
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MoRgage / Contrad inde dness unpaid as of Is the applicant the sole legal or equitable
March t, currenl year ownef? ❑ Yes ❑ No
/ 6./�lJ
If owned with someone other than spouse, indicate with whom.
of mortgagee or conVad seller (number and
Name of assignee or other owner or holder of
Address of assignee (number and street, ciry, state, ZIP code)
Does applipnt own property in arry other I If yes, what r� •-�-""
county in Indiana?
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Di ���'cr \0..........,� ,'
Deduction apprc p V , .. • •�.'i" � �
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Card -1 ,� ►.�!i�.y�p,
20 �_
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Signature _
state,
What Tauing Distrid?
f AUDITOR
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_ County Auditar
s the property in question:
❑ Real Property � Moble Hane QC G1.1-�
Has this deduction been requested on
property for curtent yeaf? � Yes � No
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Dale
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•/ We certify under ihe penalty of perjury lhat the above and foregoing information is true and corred and that the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owne s fl n me) „,, Person authorized by duly executed Power of Attomey
.J G� or by IC 6-1.1-12-.07
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FuII resident add ess of applicant
� � 2° �h� on Tti
of authorized person