HomeMy WebLinkAboutMortgage_Williams (13)�i� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
'i• FOR DEDUCTION FROM ASSESSED VALUATION
� State Form 43709 (R6 / 5-06)
� Presaibed by DepaRment of Local Gwemment Finance
�
Count Township Year
INSTRUCTIONS: OCTF'e ric
To be filed in person or by mail with the CountyAuditor of the county where the property is located. � �����%
Filing Dates: 1) Real Property: Dunng the 12 months before dune Il o/ the year the deduction is to be elfec '
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0l the year the��µ�y,��e eBective.
See �everse side for additional instaictions and qualifications. G�BSON COUNTY q�p�70R
Applicant
buyer-see
e
Tauing Distrid /
Ql�..�G�a�c�
�� -�� / 9- /o/- aac
Assessed value of real property as of
Marrh i, curtent year
H no, what is his / her exact share of interest?
name on record Is different than that of
of mortgagee or contracl seller
�¢ S
number / legal description
j fjr✓� S
Record number
— O 6 Page number � � /✓
�t�o
Mortgage / Cont ad indebte,�ness unpaid as of Is the applicant the sole legal or e
March 1, current ea/���b owneR ❑ Yes ❑ No
/
If owned wilh someone other than spouse, indicate with whom.
i i �-/
Address of mortgagee or contract seller (number and si
or other owner or holder of mortgage
(number antl st2et, clty, state, Z/P
below:
a
i• ' .
�city, state, ZIP
Does applicaM own property in any other If yes, what county?
county in Indiana9
Deduction approved in the amounl of:
20 20 20
P P
Signature
��I�a
What Taxing Distric
COUNTY AUDITOR
20
County Auditor
20
� Real
❑ Mobile Home (IC 61.1
Dra�ver NO..o �I..-, 6„�I..Y�
�
CardNO . .....................
�
Date
20
certify under the penalty of perjury that the above and foregoing infortnation is true and correcf and that the applicants was / were
lenl of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
of authorized person