HomeMy WebLinkAboutMortgage_BryantSTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S / State Fwm 03709 (RS / C-03)
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� PrescnOetl by Department ol Loral Govemment Financa
INSTRUC710NS: Fil Mark
To be filed in person or 6y mail with the County Auditor of the county where the property is located. iYi�1R � 1 2006
Filing Dates: 9) Real P�operty: During fhe 12 months before May 11 of the year the deduction is to be eflective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 olthe year the deduction��e eflective.
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See reverse side for addifional instructions and qualifications. U
GIBSON COUNTY AUDITOR
(owner ¢r1con(r�t buyer - see
Taxing Districl
\�I
reverse
number / tegal
� � �..�
Assessed vatu�.ol real property as of Mortgage / Contrect ii
March 1, curtent year March i, current year
'
If no, what is his / her exact share of interest?
It name on record is diflerent lhan that of applicant, indicate below:
Record number O
Page
unpaid as of Is the applicant the sole legal or equitable
owner? ❑ Yes ❑ No
If owned with someone olher than spouse, indicate wilh whom.
moRgagee or contrad seller �
of moAgagee or contract seller (number end st2� city, state, ZIP
Name of assignee or
Address
owner or holder of mortgage
and streef, city, state, ZIP
Does applipnt own property in any other I If yes, what county? What Ta�cing Distrid?
county in Indiana?
20. Q "/ 20
P
Signature
COUNTY AUDITOR
the amount of:
�_ 20 � 20 20
1 `
County Auditor
Is the property in question:
❑ Real Property ❑ Mobile Horrie pC Cr1.1-�
Has this dedudion been requested on
property for current yeaR � Yes � No
20
20
We certify under the penalty of perjury that the above and toregoing infortnation is true and corred and that the applicants was / were
es�ent of Indiana and owner of the aforementioned propeAy on March t, 20
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Person authorized by duly execuled Power of Attomey
or by IC 6-1.1-12-.07
/�^� Address of authorized person
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