HomeMy WebLinkAboutMortgage_HeimbuecherSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
t � Spte Form 43709 (R3 / 10-00)
,� PresaibeC Oy State Boartl of Taz Commissbrers
Instructions for filing:
To be filed in person or by mail with the County AudRor of the county where the property is
located during the 12 months before May 11 of the year ihe dedudion is to be effective; See
reverse side for additional insWCtions arxl qualfiptions.
FORM 5
Co Township Year
OCT 2 5 2001
/�� '""Mark
GIBSON COUNTY AUDITOR
Applipnt nerorcontrac buyer- see resMctions on 2verse sid � , " -
Taxing Di 'ct Key number / legal escription Record number �/
� 3'_ D��S / W Page number v
i
Assessed value of real property as of , Mortgage / Contrad indebtedness unpaid as of Is the aPplipnt the sole le al or equdable
March 1, wrrent year . March 1, current year � owneR ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with s eone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
N� of mortgagee or contred seller
.
Address of mortgagee or contrad seller (number and sVeet, city, state, ZIP . .
Name of assignee or other owner or holder of mortgage
Addressbf assignee (numtierand street, dty, state, ZlPcode) �
Does applipnt own real property in any If yes, what county? What Taxing DisUid? Has this dedudion been requested on
other county in Indiana? property for current yeaR � Yes❑ No
COUNTY AUDITOR
Deducction approved in the amount of:
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�5 (o •cd P7A'Bo � � /�
Sign ture County Auditor Date
I e certify under the penalty of perjury that the above and foregoing infortnation is We and corred and that the applicants was / were
id of Indiana and owner of the aforementioned property on March 1, 20
' n re (owners (ull name) Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
ull dent�ress oi appli nt � Addreu of authorrzed person
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