HomeMy WebLinkAboutMortgage_Buck`' �'�° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�-°' t FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
S y State Porm 43709 (R4l 70.01)
•i. �� Prescribed by DeOartmenl of Local Govemment Finance
iNSrRUCr�oNS: �AN 2 9 �nna�
To 6e �led in person or by mail with the County Audifor o/ the counly wheie the property is located.
Filing Dates: 1) Real Property: During the 12 months belore May 11 of the yea� the deduction ' o be ef(ect've.
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 f he ee e i tion to e e/%ctive.
See reverse side Ior addifional instiucfions and quali�cafions. GIBSON CO�JNTY AUDITOR
Applicant
Tauing
6uyer
Assessed value of real property as of
March 1, current year
� restnchons on 2verse s�de � B ��
Ossie � �-,2; �e - �- �g
Key number / legal de /cripOtib Dn� Record numpCp C�
..� C,1
) , �� ��O / � /` � Q Page number / J , /�— (
{� y� v
Mortgage / Conlracl indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owneR ❑ Yes ❑ No
��' 324/n..5�
no, what is his / her exact share of inlerest?
If owned with someone other than spouse, indicate with whom.
If name on record is different than thal of applicant, indicate below:
�e of mortgagee or contrad� � � J „
� / / a`�,C
Address of mortgagee or contrad seller (n er and street, city, state, ZIP
Name of assignee or other owner or holder oi mortgage
of assignee (number and street,
Does applipnt own property in any
county in Indiana?
Deduction approved in the amount of:
state, ZIP code)
If yes, what county? � What Taxing District?
COUNTY AUDITOR
r ���1'���3-�/Ar��
Counry
Is the property in queslion:
❑ Real Property ❑ Mobile Home (IC 61.1-�
Has this deduction been requested on
property for current yeaR � Yes❑ No
20 � zo �_ zo
P
Date
certify under the penalty oi perjury that the above and foregoing information is lrue and corred and lhat the applirants was / were
lent of Indiana and owner of the aforementioned propeRy on March 1, 20
name)
Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
cant Address of authorized person
a ���( � ,�,��c