HomeMy WebLinkAboutMortgage_Broshears (2),,.�
;e` � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
`\ FOR DEDUCTION FROM ASSESSED VALUATION
`�• t SUte Fwm 43709 (R6 / 5-OG) � �
�« Presaibed by Department of Local Gwemment Finance �
INSTRUCTIONS:
To be filed in person or by mail with the CountyAuditor of the county where the_ propeRy is locat��{ G 2 1 2007
Filrng Dates: 1) Real Property: Dunng the 12 months before June 11 0! the year the deduction is o be effective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 ot tbq,y.��t��uction is to 6e eflective.
Q�l
See reverse srde /or additional instrucfions and qualifrcations.
GIBSON COUNTY AllDITOR
Appllcant
Taxing
side)
Key number! legal description I Record number � O� 7
/ �G �`/_�/ �7"�����5 (o e ber % � 7
Assessed value of real property as f Mortgage ! Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
Mard� 1, current year March 1, current year owne(? "❑ Yes ❑ No `
l�3000
If no, whaf is his / her exact share of interest?
name on record is different than that of
of mortgagee or contract seller
indicate below:
Address of mortgagee or wntract seller (number and stieet,
Plame of assignee or other owner or holder of mortgage
of assignee (num6er and st2et, city, state,
Does applicant own property in any other If yes, what county?
couNy in Indiana?
Deduction approved in the amount of:
20' fl�, 20 �_ 20
P P
Signature
If owned with someone
1 than spouse, indicate with whom.
,�..,,., � �a�.�7 a � 9
s the ploperty in question: '
❑ Real Property O Mod7e Hmie pC 61.1-�
�-U �i�'F S- 2� — -- ---- --_-
state, ZIP 200'j _
G��t,d�-re s� �7
�20 4 �leriLo
. . `� �6i^ �CJ�j �/I �7/, OUO� 00
��_
What Taxing District? Has lhis dedudion been requested on
property for wrrent yeaR � Yes � No
COUNTY AUDITOR
20
Counry AudRor
20
20
Date
n
20
We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duty executed Power of Aftorney
or by IC 6-7.1-12-.07
address of applicant � L/�(,(�qddress of authorized person