HomeMy WebLinkAboutMortgage_BellSTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
- FOR DEDUCTION FROM ASSESSED VALUATION
` � Siate Fotm 43709 (R4 / t0-01)
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� Prescribe0 by Department o1 Local Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the property is located. J U IV 1 � Z��3
Filing Dates: 1) Real Pmperty: Dunng the 12 months before May 11 of the year the deduction is to be ef/ective.
2) Mobile Homas assessed under IC 6-1.1-7: Befween January 15 and March 31 0l the year the dedu tion'is to be ef/ective.
See reverse side /or additional instructions and quali(ca6ons. /���`� /��. "��
GIBSON COUi�TI' AUDITOR I
Applicant (owner o ntracf b y r- s e restri ' s o rse side)
Taxing Disirid Key number / legal description Record number O�
oCJ4��/�� � O// � h h/(�D ,.071 Page number
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Assessed value of real property as af Mortgage / Contrad indebtedness unpaid as of Is the appliqnt the sole legal or equitable
March 1, current year 'March 1, current year owneR ❑ Yes � No
55 aso� '
If no, what is his / her exacl share of interest? If owned with someone other than spause, indicate with whom.
If name on record is different ihan that of applicanl, indicate below: Is the property in queslion:
❑ Real Property ❑ Mobile Home (IC 61.1-�
'ame of mortgagee or contract seller
Address of mortgagee or contract seller (number an street, city, sta , ZIP
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Name ot assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, sfate, ZIP code)
Does applicant own property in any other If yes, what counry? What Tauing Distrid? Has lhis deduction been requested on
counly in Indiana? property for current year?� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amounl of:
20 20 �1,� 20 �1� 20 � 20 "n R 20 �� 20
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Signature County Audilor Date �1
.I/ We certify under the penalty of perjury that the above and foregoing infortnation is true and correct and that the applicants was / were
� resident of Indiana and owner of the aforementioned property on March 1, 20
Signalure (owners lull name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Full resi ent address of applipnt Address of authorized person
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