HomeMy WebLinkAboutMortgage_Kerney�ei "'A� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
's'�: FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�j • State Fwm 43709 (R6 / 5-06) . , . �
�� Presaibed by Department of Loral Govemment Finance
iNSrRUCnoNS: p��'��"^�`�007
To be tiled in person or by mail with the CountyAuditor of the county where [he p�operty is localed. .
Filing Dates: 1) Real Property: During the 12 months before June I f of the year the deduction is to be effective�-�y,,� � °�
2) Mobile Homes assessed under lC 6-1.1-7: Between January 15 and March 2 of the year the deUli�eor►tsvd9E�eliective.
See reverse srde for additional instructions and qualifications. GIBSON COUNTY UDITOR
Applicant (owner or contracf 6uyer- see iestrictions on reverse side)
�o a S`t� o e � , Sl �� � .1., • � �- �t
Taxmg Dnhie� e number / legal de
Assessed vatue of real property as of� Mortgage / Contrad ir
March 1, current year March 1, curtent year
If no, what is his / her exact share of interest? If
If name on record is diBerent than that of applicant, indicate below:
of moRgagee or contract seller
number
C'� (fl5 �
I_ Page number 5� q 5
ness unpaid as of Is the applicant the sole legal or equitable
, ownef? � ' �S ❑ No
�
:d with someone other than spouse, indicate with whom.
s> >I . , 6 , U _ : r , � ._
Address oi mortgagee or conVad seller (number and street, dty, state, ZIP � ;
Name oi asaignee or other owner or holder of mortgage
Address of assignee (num6er and street, pty, state, ZIP code)
Does appliceM avn property in any other If yes, what county?
county in Indiana9
Dedudion approved in the amounf
20 �� 20
`
Signature
What Taxing Distric
COUNTY AUDITOR
20 20 20
County Auditor
❑ Mobile Home QC 61.1-�
Dra�r�er NO �.�.- �/ 9,r
Card Np, �-
.....................
Date
We ceAify under the penalty of perjury lhat the above and foregoing informalion is true and corred and that lhe applipnts was / were
lesident of Indiana and owner of the aforemenlioned property on March 1, 20
nat e(owners full name Person authorized by duly executed Power of Attomey
)�, jw� � ��NA� J or by IC 6-1.1-12-.07
of applipnt ( f IAddress of authorized person
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