HomeMy WebLinkAboutMortgage_Earlesrt�� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�� � ! StatB Form <3709 (R5 / d-03)
:� P2scnDed by Department of Local �vemment Finance
INSTRUCTIONS: MAY O 2 Z�d�j Mark
To be filed in person or by mail with the CountyAuditor of the county where the property is located.
Filing Dates: 1J Real Property: During the 12 months be%re May 11 07 the year the deduction is to 6e eHective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the�� �n is to be effective.
See reverse side /or additional instructions and quali�cations. GIBSON COUNTY AUDITOR
Applicant
Assessed value of real property as
March 1, current year
If no, what is his / her exact share
Key�number / legal description � Record number
V/Y� — O� as �—�� Page number
Mortgage / Contract indebtedness unpaid as of
March 1, current year
name on record is different lhan that of applicant,
o( mortgagee or contred
Address of mortgagee or contrad seller (number
i�•
Is the applicant the sole legal or
owner? ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
� �
�icate below:
street, city, stafe, IP
Name of assignee_or other owner or holder of mortgage
Address o Drawer NO..GXl.�4��
...... e)
coo ntyPP�l Card NO. ...1.�..C'�.......... i?
� Loy, �Ob� o0
Deduction approved in the amount of:
20
Signature
20 D�
Taxing Disitict?
�OUNTY AUDITOR
20 �� 20 � 20
P P
County Auditor
Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
Has this dedudion been requested on
property for current year? � Yes � No
20
Date
�7�7
certify under the penalty of perjury that the above and foregoing iniormation is true and correct and ihat the applicants was / were
ent of Indiana and owner of the aforementioned property on March 1, 20
Person aulhorized by duly
or by IC 6-1.1-12-.07 �
of authorized person
c��
Power of Attorney