HomeMy WebLinkAboutMortgage_Richeson (6)�o.�n
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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R6 / 596)
Presaibea by Depanment of Local Govemment Finance
Coun Township Year
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INSTRUCTIONS: Fil �
To be filed in pe�son or by mail with the County Auditor of the county where the p�operty is located. � U N ���0��
Filing Dates: 1) Real Property: During lhe 12 months befo2 ,lune Il o/ the year the deduction is to be elfective.
2J Mobile Homes assessed under IC 6-1.7J: Between January 15 and March 2 of the year the � u�� ��J� effective.
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See reverse side for additional instnictions and qualifications. U
GIBSON COUNTY AUDITOR
Applicant (ow e or contract buyer- s restric6ons on reverse side)
Tauing Distrid Key number / legal desc�ripppplion Record number
��`� Page number
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Assessed value of real property as of MoRgage / Contrad indebtedness unpaid as of Is lhe applican���t th.�e"""sole legal or equitable
March 1, curcent year March t, current year owne(? �res ❑ No
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If no, what is his / her exact share of interzs[ % If owned with someone other than spouse, indicate with whom.
If name on record is different lhan that of applicanl, indicate below: Is the property in question:
Property ❑ Mobile Home (IC 61.1-�
' me of moAgagee or contred seller
Address of mortgagee or conVad seller (nu b r and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Dces applicant own property in any other If yes, what wunty? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for wnent yea(? � Yes ❑ No
COUNTY AUDITOR
Deduction appro� ed in the amount of:
ZO _�g_ 20 �q_ 20 20 20 20 20
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Signature County Auditor Date
'/ We certify under the penalry of perjury that the above and foregoing information is true and correct and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners /ull name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07 .
ull resident address of applicant Address of authorized person
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