HomeMy WebLinkAboutMortgage_Cook`•"� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
SWte Fortr:43709 (R5 / 4-03) �
�, Presaibetl 6y Department ol Local Govemment Finance �
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INSTRUCTIOfJS: �UL O 5 Z�FI�Mark
. To 6e �led in person or by mail with the County Auditor o/ the county where the property is located.
Filing Dates: 1) Real Properry.� During the 12 months 6elore May 11 0/ the year the deduction is to ctive ,{�,�,
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o/theby a�(f� edu� c�n is to be effective.
See reverse side (or additional instructions and qualifrcations. GIBSON COUNTY AUDITOR
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Applicant (owner or � ontract buyer - s e restnct/Wis on rev rse side)
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Taxing Distrid Key number / legal description Record number
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D�l 3 _ � ��Sa _ � Page number
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Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applica t the sole legal or equitable
March 1, wrrent year March 1, currenl year owner? ,�es ❑ No
�,5 000 - -
If no, what is his / her exact share of interest? Ii owned with someone other than spouse, indicate with whom.
if name on record is diHerent than that of applicant, indicate below: Is the property in question:
Property ❑ Mobile Home pC E1.1-�
�me of mortgagee or contract sel�er �/
3
Address of mortgagee or contraa seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? Wha� Taxing District? Has this deduction been requested on
county ir Indiana? � propeAy for current year?0 Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
zo � Zo _�. zo 0 9 zo 2o zo 20
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SignaWre � County Auditor Date
We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners (ulI name� Person authorized by duty executed Power of Attorney
or by IC 6-1.1-12-.07
FuII esident addr s of applicant Address of authorized person