HomeMy WebLinkAboutMortgage_CoomerSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION Coun Townshi Year
/ Sute Form 43709 (RS / d-03) - . .
� Prescribed Dy Department of Local Govemment Financa
INSTRUCTIONS: MAR O Fl Z��Mark
To be filed in person or by mail with tbe County Auditor of !he counry where the property is located.
Filing Dates: 1) Real Property: Dunng fhe 12 months betore May 11 of the year fhe deduction is to be eflective. '
2) Mobile Homes assessed under IC 6-1J-7: Between January 15 and March 2 of the ye�{1t�te,de'Ct�ction is to be eHective.
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
(owner or contract
Taxing Dislrid
Assessed value of real propeAy as
March 1, current year
If no, what is his / her exact
see re cnons on side)
%
ey number / ' al de.l
D /�-
� MoRgage / Contrad in
March 1, currept year
name on record is difterent than that of applicant,
of mortgagee or contract selier
below:
Address of mortgagee or contrad seller (number af�d stieet, city,
Name of assignee or other owner or holder of mortgage
(number and st�eet, city, state, Z/P code)
�
�U�� (� �W I
btedness unpaid as o
Soi..� ��
�y,000
Record number
Page number
is the applicant the sole legal or
owneR ❑ Yes ❑ No
If owned with someone other than spouse, indicate witn whom.
Does applicant own property in any other I If yes, what county? �
county in Indiana? - -
�
Dra���er NO..... �.' ��/ 5
Deduction approvea
20 �
SignaWre
Card NO. .:.�.'.� :........: .
_� � , .
� � � �
County Auditor
We certify under ihe penalty
�esident o�lndi2ha and owne
(ull name)
What Taxing District?
UDITOR
20
Is the property in question:
❑ Real Propaly ❑ Mobile Hmie pC 61.
Has this deduction been requested on
property for wrrent yeaR � YesO No
20
Date
20
ierjury that the above and foregoing information is true and corred and lhat the applicants was / were
the aforementioned property on March t, 20
Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person