HomeMy WebLinkAboutMortgage_Lee� R�" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�° : FOR DEDUCTION FROM ASSESSED VALUATION
t > Sfate Fwm 43709 (R3 / 70.00)
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Prescribed by State Boartl of Taz Cortunissioners
InstrucUons'for filing:
To be filed in person or by mail with the County Auditor. of the county where the property is
located during the 12 months before May 11 of the year the dedudion is to be effedive. See
reverse side for additional instructions and qualifications.
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NOV 2 6 2001
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3_� 1 _ �O Q� Q� �, GIBSON COUN7v aUDITOR I
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Applicant wner or contract buyer - e restrictions on 2ve .
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Tauing strict Key number / legai.descriplion Record number �/
/ � � _ � / � M Page number
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applirant the sole legal or equitable
March 1, wrrent year March 1, curreni year owner? ❑ Yes ❑ No
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If no, what is his / her exacl share of interest? If owned with someone other than spouse, indicate with whom.
If name on rewrd is different than that of applicant, indicate below:
P� of mortgagee or contrad seller o
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Address of mortgagee or contrad seller (number and st2et, city, state, ZIP
Name of assignee or.other owner or holder of mortgage
Address of assignee (numbe� and street, city, state, ZIP code)
Does applicani own real property in any If yes, what county? What Taxing District? Has this deduciion been requested on
other wunty in Indiana? property for current year? L7 Yes 0 No
COUNTY AUDITOR
Deduction approved in the amount ot:
zo zo Q�_ Zo zo zo � zo 0 7 zo � b 9
5.ro Pra�aer� Pv"R�d 9Q' � j° � P
Signat re Counry Auditor Date
�i� e certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
ident of Indiana and owner of the aforementioned property on March 1, 20
Signat e(owners full name Person authorized by duly executed Power of Atlomey
u C or by IC 6-1.1-12-.07
Fu I resi addres f applican Address of authorized person
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