HomeMy WebLinkAboutMortgage_Jackson (3)STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
's � � State Fortn 43709 (R5/ 4-03) . � ,
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� PraudECd by Departmem of Lotal Gtivemment Financa
iNSrRUCrior�s: qPR 1 5���6t�
To be filed in person or by mail with the County Auditor of the county where the propeKy is located.
Filing Dates: 1) Real Property: During the 12 mon[As before May 11 oI the year the deduction is to be eflective. �!
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year�dedut�hdrY�Ls2to be eflective.
See �everse side Jor addilional instructions and qualifications. GIBSON COUNTY AUDITOR
��
Applicant (�r or cont2ct buyer � see ,r�.
�_
Taxing Distrid
�,.
Assessed value of real property as of
March 1, current year
16no, what is his / her exact share of intere;
If name on
-1,.3 � 3C� o00 7 -
on reverse s�ue)
Key number / legal description Record numb
�0� � ,
� �_ � � ' � Page number / � �i • •
3 -e� d
MoAgage / ContraU indebtedness unpaid as of Is lhe apptica t the sole legal or e
March 1, «ent year ownef? �s ❑ No
�5y97� �i �
Ii owned with someone other than spouse, indicate wilh whom.
than that ot applicant, indicate
mortgagee or contrad
ss of mortgagee or contrec( seller (numbg/and stieet,
of assignee or other owner or holder of mortgage
Address of assignee (nurri6er and st2et, city, state, ZIP code)
Does applicant own property in any other I If yes, what county?
county in Indiana?
Deduction approved in the amount of:
20
state, ZIP
Is the property
❑ Mobile Home (IC 61.
'� - -- —
- Drawer NO....°Z..��..•••••
T Card NO. ..... ��.��.. I........ ted on
.�.� c� � �°��_ ��- � }s � No
COUNTY AUDITOR
20 '�b 20 �_ 20 20
P P
County Auditar
20
Dale
�
6
i
We certify under the penalty of perjury that the above and foregoing informalion is true and corred and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
natur (owners full name) ' Person authorized by duly executed Power of Attomey .,
� �_ or by IC 6-1.1-12-.07 '•.`
sident dr ss of applicant Address of authorized person \
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