HomeMy WebLinkAboutMortgage_RobersonSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�+ / State Fwm 43709 (RS / 4-03�
� PrescriGed by Department of Loral Gtivemment Finance
Coun Township Year
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wsrRUCnoNS: NOV 2 ��Pli u`�`�`
To be �led in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: f) Real Property: During the 12 mon[hs before May 11 oI the year the deduction is to be eHective.
2) Mo6ile Homes assessed under IC 6-1.1 J: Between January 15 and March 2 0/ the yea�lhe�deductidn.is to be effecfive.
See reverse side for additional instructions and qual�cations. � �
GIBSON COUNTY AUD170R
Applicant(ow rorcontractbuyer-see n
�
Taxing Distrid
�Q�C�Qi1l �-C
Assessed vatue of real property a
March 1, current year
If no, what is his / her exact share of interest?
If name on record is different than that of appl
�ney�mortgagee or contrad seller
on
Key number / legal description
> . t��. , w
Mortgage / Contrad
March 1, current ve:
below:
Record
Page number � �
unpaid as of Is the applicant�sole legal or
ownef? es ❑ No
If owned with someone other than spouse, indicate with whom.
Address of moRgagee or contract seller (number and street, city, �state,
Name of assignee or olher owner or holder of mortgage
Is the property
❑ Mabile Hane (IC Cr1.1
Address of assignee (num6er and st2et, city, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Taxir I)����'S�� � �'a3•OS ;ted on
county in Indiana? G��y � a��,�'��� 's ❑ No
' L�CSi1 M
COUNTYAUDITOR� 5'� /Y)OC�jfIGt v���
Deduction approved in the amounl of: �O„d �_
20
Signature
Za P 20 Q I 2� I 20
County Auditor
20
Date
20
certify under the penalty of perjury that the above and foregoing infortnation is lrue and corred and that the applicants was / were
fent of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly execuled Power of
or by IC 6-1.1-12-.07
I reSident address of a�plicant �Address of authorized person
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