HomeMy WebLinkAboutMortgage_Williams (11)��n 4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'�r FOR DEDUCTION FROM ASSESSED VALUATION
��j • State Fwm 43709 (R6 / SO6)
Presaibed by Depariment of Lo�l Govemment Finaixe
INSTRUCTIONS:
To be filed in pe�son or by mail with the County Audito� of the county whe�e the property is located. AI(� �/ 2 1 2��6
Frling Dates: 1) Real Property: During the 12 months before June 17 0/ the year the deduction is to be effelklve.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year� —tyhe�, deduction is to be effective.
See reverse side /o� additional instructions and qual�cations. o,(a� ��
GIBSON COUNTY AUDITQR
Applicant
Taxing
buyer- see restrictiqns on reverse
Assessed value of real property as
March 1, wrrent year ,
If no, what is his / her exad share of interest?
If name on
Key number / legal descriplion Record number
�G ��e�-.3osLo�oo� G�8- aa 9 G1�J �
_ _ � Page number �% /
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MoRgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, rtent year ownef? ❑ Yes ❑ No
�a aoc�
If owned with someone other than spouse, indicate with whom.
than that of applicant, indicate below:
moAgagee or conired seiier ��
ot moRgagee or conlraIX seller (number and s eet, city, state, ZIF
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, ciry, state, ZIP code)
Does applicant own property in any other If yes, what county?
county in Indiana?
Dedudion approved in the amounl of:
20 20 20 Q
� 1 Q
Signature
Is the property in question:
� � � Reai Propertv- �°�� ile Home pC 61.1-�
vC;����er'�Q •�- �'���.: .
55t ... �,
Card��. .•���,��p. �
What Taxing District? Has this dedudion been requested on
property for wrrent yeaf? � YesO No
COUNTY AUDITOR
�
County Auditor
20
20
Dale
�
' We certify under the penalty of perjury that the above and toregoing information is true and corced and lhat the applicanls was / were
resident of Indiana and owner of the aforementioned properry on March 1, 20
�a eJ (� n s(ull name���� ���� Person authorized by duly executed Power of Attomey
VY l j or by IC 6-1.1-12-.07
Address of authorized person
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