HomeMy WebLinkAboutMortgage_Gossett��� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'F FOR DEDUCTION FROM ASSESSED VALUATION
R• _ ! State Form 43709 (R5/ a-03)
� M PrescnDeC by Department ot Local G6vemment Finance
Coun Township Year
INSTRUCTIONS: File Mark
To be liled in person or by mail with the CountyAuditor of the county where the property is loca
Filing Dates: 7) Real Property: Dunng the 12 months before May 11 of the y e �ct�on b eff tive.
2J Mobile Homes assessed under IC 6-7.1-7: Between January�n�a�h z the y�e deduction is fo be eflective.
See reverse side lor additional instructions and qualifcations.
g 1�
MAY 1 p 2005
Applicant (ow/�ror n racf buye e resfnctions on rev e side)
�
Taxing District�— I Key number / legal description
� �
Assessed value oXc�al property as of
March 1, current year .
If no, what is his / her exact share of interest?
Mortgage / Contracl ii
March 1, current year
��V 1 �
If name on record is different than thaf of applicant, indicate below:
�me of mortgagee or coniract seller .�/�
�ilittal AN
Address oi moAgagee or contrad seller (number and street, city, s
Name of assignee or other owner or holder o( mortgage
Address of assignee (num6er and street,
Does applicant own property in any
county in Indiana?
Deduction approved in fhe amount of:
20 D �
Signature
20 �
;ity, sfate, ZIP code)
If yes, what wunty?
GIBS� � N �����'
� _ � Page number
unpaid as of Is the applicant the sole legal or equitable
owner? ❑ Yes ❑ No
Ii owned with someone other than spouse, indicate with whom.
ZIP
What Taxing District?
COUNTY AUDITOR
20 20 20
Q P
County Audilor
Is ihe
O Real Property ❑ Mobile Home (IC 67.7-�
Has this deduction been requested on
property for wrrent year? �] Yes ❑ No
20
20
' We certify under the penalty of perjury that the a6ove and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of ihe aforementioned property on March 1, 20
C
�n auihorized by duly executed Power of Altorney
IC 6-1.1-12-.07
Address ofauthorized person