HomeMy WebLinkAboutMortgage_Heacock,+��"'F STATEMENT OF MORTGAGE OR CONTRACT
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+► INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
r County Township Year
�� VALUATION State Form 43709 (1-90) Prescribed by the
� State Board of Tax Commissioners
Instructions for filing: DEC 2'� F��dvlark
To be filed in person or by mail with the County Auditor of the county where the � /J
property is located during the 12 months before May 11 of the year the deductio/�^\ J✓�F_/ yf . �. D
is to be effective. See reverse for additional instructions and qualifications. `�k��'`"��"`�i
GIBSON COUNTY AUDITOR
Applicant (Owner or contract buyer - see restrictions on reverse) �
�
Taxing District Key Number/Legal Description ecord o�0 � 7�f �%.3
� - �J Page No.
Assessed value oi real operty as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of March 1, current year. equitable owner? O yes � no
0 7d y U
If no, what is his/her exact share or interest? If owned with someone other than spouse,
indicate with whom.
If name on record is different than that of applicant, indicate below:
^�ame of mortgagee or contract seller �
Address of mortgagee or contract seller
Name of Assignee or other owner or holder of Mortgage.
Address of Assignee ' '
Does applicant own real property If yes, what county? What Taxing District? Has this deduction been
in any other county in Indiana? requested on property for current
year? rJ yes ❑ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19_� f�-a��(� 19_�3 19 1�� 9 b� 19� 0 8
0 �
'''S' b� %'o� - oi4 (o�a PT(�Ba
Signature � _ Secretary of Board of Review Date
P
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
"- nts was/were a resident of Indiana and owner of the aforementioned property on March t, 19
t re (owners full ame) Person authorized by duly executed Power of Attorney or
by IC 6-1.1-12-.07).
ull Resideni Address of Aplicant Address of Authorized Person
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