HomeMy WebLinkAboutMortgage_Gainesi i �, STATEMENT OF MORTGAGE OR CONTRACT INGEBTEDNESS
i� = FOR DEDUCTION FROM ASSESSED VALUATION
^ �j State Form 43709 (R6 / 5-06) �
� Presoibed by Department of Local Gwemment Finance
INSTRUCTIONS:
To be /iled rn person or by mail with the County Audito� o/ the county whe�e the property is located.
Filing Dates: 1) Real Property: Dunng the 12 months be/ore June 11 of the year the deduction is to be elf���ve.2 5 ZOO %
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 2 0/ the year the deduction is to be elfective.
See reverse side !or additional instructions and qualifications. a�
U �6 �
_ . GIBSON COUNTY AUDITOR
Applicant
Taxing
on reverse
Key number / legal description
�
number
number
Assessed value of real property as �f � MoAgage,/ Contrect indebtedness unpaid as of � Is the applicant the sole legal or equitable
March 1, current year LI March 1, wrtent year owneR ❑ Yes � No �
�3 SDOD
If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the orooertv in ouestion
mortgagee or conVaG seller
Address of mortgagee or contrect seller (number and/st
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP
city, state, ZIP
Does applicant own property in any other I If yes, what county? What Taxing Dislrid?
county in Indiana?
20 �j
P
Signature
approved in lhe amount of:
20
0
D r a��� e r,\',O. ..o�,OQ �. .. ..
Card N�• • U' 3 S 00�0 ��
`�t
_ — ( ., _
_ County Auditor
O Real Property ❑ Mobile Home QC 61.1-�
Has this dedudion been requesled on
property for current yea(? � Yes � No
20
20
certify under the penalty of perjury that the above and foregoing information is true and corred and lhat the applicants was / were
lent of Indiana and owner of lhe aforementioned property on March 1, 20
0
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
resident address of applicant U� � IAddress of authorized person