HomeMy WebLinkAboutMortgage_Cox (8)rt�" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-° : FOR DEDUCTION FROM ASSESSED VALUATION
S J Slate Fortn 43709 (R4 / 10-01) '
�� Prescribed by Department of Local Govemment finante
INSTRUCTIONS:
To be filed in person or by mail with fhe County Auditor of fhe county where the property is located. F
Filing Dates: 1) Real PropeRy: During the 12 months before May 11 of the year the deduction is to be effecrg � 5 200
2) Mo6ile Homes assessed under IC 6-1 J-7: Befween January 15 and Marcb 31 0( e year the deduc6_ . on is to-�flective.
See reverse side /or additional instructions and qualificatlons. ���^-t
� GIBSON COUNTY AUDITOR �
Applicant (owne� c tract buyer - s re�tri ti s on reverse side)
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Taxing Dislrid Key nu er / legai description Record number
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Assessed value of real property of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, cu ent yea owne(? ❑ Yes � No
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If no, what is his / her exact share of inierest? If owned with someone other than spouse, indicale with whom.
If name on record is different ihan that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Horrie (IC G1.1-�
�ame of mortgagee or contrad seller
Address ot moRgagee or contrect seller (number and street, uty, state, ZIP
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Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Taxing Distrid? Has lhis deduclion been requesled on
county in Indiana? property for curcent yeaf? � Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
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Signature County Auditor Date
1/ We certify under the penalty oi perjury that the above and foregoing informalion is true and corred and that the applicants was / were
� resident of Indiana and owner of the aforementioned property on March 1, 20
Signalure�er (ull name) Person authorized by duly exewted Power of Attomey
� or by IC 6-1.1-12-.07
Full resident address of ap ipnt Address of authorized person
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