HomeMy WebLinkAboutMortgage_Dyer,.• ^,'.n
i�STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
, State Fortn 43709 (R6 / 5-06)
��• Presaibed by DepaNnent of Local Gwemment Finance
iNSrRUCnoNS: FEB 5F��e�
To be /iled in person o� by mail wdh !he County Auditor of the county where the p�operty is located.
Filing Dates: 1) Real P�operty: Dunng the 12 months before ,lune Il of the year the deductron is to be efle�cf-iyv,e.,.'
2J Mobile Homes assessed under IC 6-i.1-7: Between January 15 and Ma�ch 2 o(the year th�q@�e+�� be eflective.
See �everse side fo� additional instructions and qualifrcations. GIBSON COU/NTY AUDITOR
Applican wnglorcontract buyer- see restrictions on reverse side)
q� Y
Taxing Distrid Key number / le descriplion Record number
00 - UO. .�-00 J
a26 -� �� �"� � Pa e number
9ys-vo<v 9 BiYy
Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
/D� .5� 0
If no, what is his / her exacl share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is difterent ihan that of appticant, indicate below: Is the property in question:
� Real Ropelly ❑ Mobile Hane QC 61.1-�
e of moAgagee or contrad seiler
Address of mortgagee or conVaIX seller (number a st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage — _ _
Address of assignee (num6er and st2et, city, state, ZIP code)
Dra�►•er i\'0..�„�„�%' �/�LS[
;.
Dces applicant own property in any other If yes, what county? What Ta '� on
county in Indiana? Card NO ^ i No
• ..:..................
�/V„ � �i ,
��. /<>/, �Ou, ..
COUNTY AUDITC..
Deduction approved in the amounf of:
20 O`i 20 �_ 20 20 20 20 20
D O
�
Signature County Auditor Date
' We certiTy under the penalty of perjury that the above and (oregoing information is true and corred and that the applicants was / were
asident of Indiana and owner of the aforementioned property on March 1, 20
Si ers full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
� Full resi ent address o cant Address of authorized person
(���5 i3oo� f��1�„df� —' (obo