HomeMy WebLinkAboutMortgage_Blairidi � 4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
's'�� FOR DEDUCTION FROM ASSESSED VALUATION
,
� ,u� ! State Fortn 43709 (R6 / 5-06) . .
Presaibed by Depariment of Loql Gwemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor o/ the county whe�e the propeRy is located.
Filing Dates: 1) Real P�operty: Dunng the 12 months before June 11 0! the yea� the deduction is to be eH��. 1 3 ZOO J
. 2J Mobile Homes assessed under lC 6-1.1-7: Between January 15 and March 2 0/ the year the deducUon �iis t�o be elfective.
See reverse side for additional instructions and quali�cations. ����+�
U
GIBSON COUNTY AUDITOR
Taxing Dislrid
(QC2uE%�
Assessed value of real pro{
March 1, currenl year
of
what is his / her exact share of
��o^ ,BVerse side)
t.<,v c.
Key number / legal description Record number
07
� ����`%��'f�000:�'.pp agenumber 7a7
Mortgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, current year ownef? ❑ Yes ❑ No
_ aa�°o-o
eresl? If owned with someone other than spouse, indicate with whom.
If name on record is different lhan ihat of applicanl, indicate below:
me of mortgagee or contrad seller
Address of mortgagee or contrad seller (number and street, , state, ZIP
_ .. .. i. l._..
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand street, ciry, state, ZIP code)
Does appliwnt own property in any other If yes, what counry? What Taxing Distrid7
county in Indiana?
COUNTY AUDITOR
Dedudion approved in the amounf oi:
20 � ` � �,. G I 20
: �
� � ,....
Dra�ver N�.QZ•.......
__ _�
Signature
Card ��• • . ......... ....
s e property ir
❑ Real Property
5
❑ Mobile Home QC
Has this deduction been requested on
property for wrtent yearl � Yes� No
20
Date
20
We certify under the , ...., euove and foregoing information is true and correct and thal the applicants was / were
resident of Indiana an� _..,,<� or the aforementioned property on March 1, 20
�nat re owners lull name) Person authorized by duly executed Power of Attomey
i� ���� �. �,��� or by IC 6-1.1-12-.07 _
✓
II resident ddress of applicant _ ddress of authorized person
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