HomeMy WebLinkAboutMortgage_McConnellSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
- FOR DEDUCTION FROM ASSESSED VALUATION
` J Sfate Form 43709 (R3 / 70-00)
" � PresaibeE Ey State Board of Taz Comrttissioners
�
InsWctions for filing:
To be filed in person or by mail with the County Auditor of the county where the property is
located during the 12 months before May 11 of the year the dedudion is to be effedive. See
reverse side for additional insWCtions and qualfiqtions.
fORM 5
Coun Township Year
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JUL �;�6�(�U1
GIBSON COUM7Y AU�
Applicant (owner contract buye�- see restnctions o�eisp, si ) .. -
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Taxing DisUid Key number / legal desuiption Record number �
_ / � _ Page number / , n � �
� t �
Assessed value o r I property as af Mortgage / Contracl indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, current y _. March 1, current�year owneR ❑ Yes � No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
, . _ , n. , b7- 3i�3q
If name on record is difierent than that of applicant, indicate below:
��e of mortgagee or contract seller
Address of mortgagee or conVad seller (number and tre , city, tate, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sVeet, city, state, ZIP code) �
Does applicant own real property in any If yes, what county? What Taxing DisVid? Has this deduction been requested on
other county in Indiana? properiy for current yea�? � Yes❑ No
COUNTY AUDITOR
Dedudion approved in the amount of:
20,� �_,/ 2� 2� 20 � 2� G 6 Z� Q� Zo � P
d ��� P ��o�- P P
Sig ature Counry Audkor Date
I/ We certify under the penalty of perjury that the above and faregoing infortnation is W e and corred and that lhe applicants was / were
ident of Indiana and owner of the aforementioned property on March 1, 20
S��natur ers full name) ��C -^ Persan authorized by duly executed Power of Attomey
�� G L+i..[.,e�i%�r or by ic s-�.�-i2-.o�
Fuil reside d applipnt Address of author¢ed person
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