HomeMy WebLinkAboutMortgage_Ash (2)�° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'_ : FOR DEDUCTION FROM ASSESSED VALUATION�� Coun Township Year
S j S�ate Fortn 43709 (R4 / 10-Oi) � ULY ENTERE� FOR TAXATION
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Prescribe0 by DepaNrenl o( Laal Govemment Finarice Su 'ect to final ac ptance for transf r
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INSTRUCTIONS: �1Ay lo File Ma�udiror
To be filed in person or by mail with the County Auditor o! the county where th pr�erty is W ed. Gibwn County
Filing Dates: 1) Real Property: D�ring the 12 months be%�e May 3 0/ the the_ uct .
2) Mobile Homes assessed under IC &1.1-7: Belwe ' anua��Uritai�c�i �aP�(�h� year the deduction is to be eHective.
See reverse side (or additional instructions and qualifications. G�gS�N
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Applicant (owner or cont ct uyer - see resfrictions on re erse side)
Taxing DiSttid � Key number / legal description Record number
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� � G�� Page number
Assessed value of real property as of MoRgage / Contrad indebtedness unpaid as of Is the applicant e sole lega or equitable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
3 dOOo�
If no, what is his / her exacl share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is lhe property in question:
❑ Real Property O Mobile Home (IC 61.1-�
e of mortgagee or contrad seller �
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Address of mortgagee or contrect seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Tauing District? Has this dedudion been requested on
county in Indiana? property for cunent yea�? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amounl of:
20 �� � 20 20 Q� 20 20 � 20 �z 20 �� �
5�-�v P-N�a o° �� P P
Sign ture County Auditor Date
We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and ihat the applicants was / were
.esident of Indiana and owner of the aforementioned property on March 1, 20
ig ure (owners full name) Person authorized by duly executed Power of Attomey
' or by IC 6-1.1-12-.07
F II esid nt address of plicant � Address of authorized person