HomeMy WebLinkAboutMortgage_Church (2);•'-'� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�' � � ��� State Forto 43709 (RS / q.03)
� PrescriDed Ey Department o( Loca� Govemment Finance
�
Coun Township Year
�� � `
INSTRUCTIONS: SEP �� G�(�JS
To be liled in person or by mail vnth the County Auditor o) the county where the property is located.
Filing Dates: i) Real PropeRy: Dunng the 12 months belore May 11 of the year the deduction is to be effec6 a� ,Q �
. 2) Mobile Flomes assessed under IC 6-7.1-7: Between January 15 and March 2 01 the year the dedkation i�be e/(ective.
See re4erse side /or additional instructions and qualifications.
GIBSON COUNTY AUDITOR
Assessed value of real property
March 1, wrrenl year
�r- see M tions on reverse side)
Key number / legal description
,
�l�v - O/ I �-l-cl�
s of Mortgage / Contract indebtedness
March 1, wrrent year
If no, what is his / her exact share of
Record number ;,�f���
�i/
Page number
�
unpaid as of Is the applicant the ole legal or
owner? ❑ Yes ❑ No
� JU
If owned with someone other than spouse, indicate with whom.
If name on record is different lhan that oi applicant, indicate below:
time of mortgagee or contrad seller �
Address oi mortgagee or contract seller (num er and slreet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
(numberand stieet, city, state, ZIP
Does applicant own property in any olher I If yes, what county?
cowity in Indiana? ,
Deduction approved in the amount of:
20 � �/ _ 20
� /
Signature
Is the property
❑ Real Proper
❑ Mobile Home (IC 61.1-�
Drawer NO.«�:�!-'.::.......
Card \'O. ....�Jr. �!l I...........
� '7��850.pD 9-5�5
What Taxing Distrid?
COUNTY AUDITOR
20�� 20 20
V
County Auditor
Has lhis deduction been requested on
property for wrrent year? � Yes ❑�No
+.�7�
20
We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
�esiden� Indiana and ownerof the aforementioned property on March 1, 20
Person authorized by duly execuled Power of Attomey
or by IC 6-t.t-12-.07
of applicant Address of authorized person
,�Oh S�. � �nyN� �%� �. -