HomeMy WebLinkAboutMortgage_Scales`° rt'° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
�� J Slate Form 43709 (R4 / 10.01) � . —y �
Prescribetl by Depanment ot Loral Govemment Finance
INSTRUCTlONS: SEP 11 20�eMark
7o be filed in person or 6y mail with the County Auditor of the counly wheie the property is located. //
Filing Dates: i) Real Property: Dunng the 12 months 6efo2 May 11 of the year the deducti is to be eIf ctiv_ �j ��
2) Mobile Homes assessed under IC 6-1.1-7: Befween January 15 and Marc��he y,thp�d�ducf' �' o be effective.
See reverse side lor additional inshuctions and qualifications. GIBSON COU,1 ��:��pi70R I
Applicant
Distrid
side)
number / legal description
�l� —f� 1Sh 2'�l �� Page number ��
�O CJl��7O
Assessed value of real property Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, curren�ear owner? ❑ Yes ❑ No
If no, what is his / her exacl share of interest?
name on record is diHerent than that
of mortgagee or contraIX seller
of
of mortgagee or conVact sefier (number
If
indicate betow:
id s ree��
or other owner or holder of mortgage
of assignee (number and street, city, state, ZIP code)
sai
with someone other than spouse, indicate with whom.
Is the property in queslion:
❑ Real PropeAy ❑ Mobile Home QC 61.1-�
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? propeAy for current yeaf?� Yes� No
20
approved in lhe amount of:
,�' • �.
COUNTY AUDITOR
20 n_r � 20
�
County Auditor
20 �
20 �_
1
Date
20
�
certify under the penalty of perjury lhat the above and foregoing information is true and correct and lhal lhe applicants was / were
ient of Indiana and owner of the aforementioned property on March 1, 20
re (owners (ull
G.��- �
resident address c
2.2-Z We�
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
of authorized person