HomeMy WebLinkAboutMortgage_JenkinsSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�� J State Portn d3709 (RS / 4�03)
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Presai�9d 6y Depa'nm¢nt of local Govemment Finance
Coun Township Year
� 7 11
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INSTRUCTIONS: File Mark '
To 6e filed in person or by mail with the CountyAuditor of the county whe�e the property is located. S E P 3 � Z�05
Filing Dates: 1J Real Property: Dunng the 72 months be%re May 11 0l the year the deduction is to be eflechve.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0! the year the� -dye�d,uction is to be effective.
See reverse side tor additional insWCtions and qualificafions. �,(a� '6 �
�% _ _ I 2 . G ,� 2� � � / �' �O / GIBSON COUNTY AUDITOR
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Applicant�ner or contracf 6u�e� se stnctions on ieverse side) n �
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Taxing
Key number / legal description Record number O�
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Page number
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Assessed value.of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitabie
March 1�, current year March 1, wrrent year owner? ❑ Yes ❑ No
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If no, what is his / her exact share
Ii owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
�ime of mortgagee or contract sell�r-`�
Address of mortgagee.or contraq seller (numberand street, city, state, �P
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? What Taxing Distnct?
county in Indiana? � �
Deduction approved in the amount of:
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Signature
COUNTY AUDITOR
2� P I 2� P 2� 2�
County Auditor
❑ Real Property ❑ Mobile Home QC 61.1-�
Has this deduction
propeAy for wrrent
20
Date
20
iested on
Yes❑ No
We certify under the penaity of perjury lhat the above and foregoing information is true and corred and that lhe applicants was / were
e�SiQent of.lndiana and owner of the aforementioned property on March 1, 20
Person authorized by duty execuled Power of Attomey
or by IC 6-1.1-12-.07
of authorized person