HomeMy WebLinkAboutMortgage_Thomas�" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION
ti � Slate FOrtn 43709 (R4 / 16-01)
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P�escriDeO by DeparMen� of Loral Govemmeni Finarxe
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INSTRUCTIONS:
Coun Township Year
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File Mark
To be filed in person or by mail wifh lhe County Auditor of the county whe�e fhe property is focated. �"jQY � q 20�3
Filing Dates: 1) Real Property: During the 12 months belo2 May 11 o/the year fhe deducUon is to be elfective. �
2) Mobile Homes assessed under IC 61.1-7: Behveen January 15 and March 31 of t year the deducHon is to be eflective.
See reverse side /or additional instructions and qualifica6ons. �J
� GI3SON COUhT"��
Applicant (owner or contract - see restrictions on r side)
Taxing Distrid Key nu er / legal description Record number �
CP�.I�� doa-��y-o� o
Page number
�y
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, wrrent year March 1, currenl year owner? ❑ Yes ❑ No
�d o� - 3- - -��G��a��
If no, what is his / her exacl share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that ot applicant, indicate below: Is lhe property in question:
❑ Real Property ❑ Mobile Home QC 61.1-�
ame of moAgagee or contrad seller �� 7�� ` 1' ^
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Address of mortgagee or contract selier (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and st2et, city, state, ZIP code)
Dces appliqnt own property in any other If yes, what county? What Ta�cing Distrid? Has this deduction been requested on
county in Indiana? property for curtent yeaR 0 Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 � 20 � 20 � 20 �`� 2o D �{�
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Signature County Audflor Date
I 1 We certify under the penalty oi pe�ury lhat lhe above and foregoing infortnation is lrue and cortect and that ihe applicants was / were
� resident of Indiana and owner of the aforementioned property on March 1, 20
Sign ure owners (ull name) Person authorized by duty executed Power of Attomey
�,�_ or by IC 6-1.1-12-.07
ull re dent address of applicant Address of authorized person
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