HomeMy WebLinkAboutMortgage_Collins (2)f�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
J State Form 43709 (R6 / 5-0G)
� Presaibed by Department of Local Govemment Finance
INSTRUCTIONS: FEB ] 9F�P1U0 �
To be filed in person or by mail with the CountyAuditor of the county where the p�operty is located.
Filing Dates: 1) Real Property: During the 12 months before June I f of the year the deduction is to be eSect've. �y �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the yea�tictlef� to be e8ective.
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See reverse side /or additional instructions and qual�cations. GIBSON COUNTY AUDITOR
Applicant (owneiorconhact buyer- see restrictions on reverse side)
Taxing Distrid Key number / legal description
i
� � � -
Assessed value of real property as of Mortgage / Contrad indebtedne
March 1, wrtent year March 1, current year
If no, what is his / her exad share of interest?
If name on record is difierent than that
of moAgagee or contrad seller
a
below:
Record number
number
as of Is the applicant the sole legal or equitable
owneR �es ❑ No
If owned with sameone other than spouse, indicate with whom.
Address of mortgagee or contract seller (number and street, aty. state, ZIP
assignee or other owner or holder of mortgage
aaaress or assignee (numoer and sneet, Gry, state, L��' code)
Dces applipnt own property in any other If yes, what county7 What Taxing Distrid %
county in Indiana?
Deduction approved in lhe amount of:
20 � 20 Q� 20
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Signature
COUNTY AUDITOR
3�7
Counry Auditor
20
ie property in question:
Reat Property ❑ MobBe Home pC 61.1-�
.,
......
D1'II\V'�1. �Q �.....
�
C:ll"(i \�. ....� I.�...........
�ya,gyo.�— ',
..,....�� �en requested on
I property for curtent yea(? � Yes � No �
20
20
certify under the penalty of perjury that the above and foregoing infortnation is true and corted and ihat the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
ue (o ers /ull name) Person authorized by duty executed Power of Attomey
/� � � �,�,�- or by IC 6-1.1-12-.07
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person