HomeMy WebLinkAboutMortgage_Lentz��
d �
a'
�«. '
�
STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNEcc
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R6 / 5-OG)
Presaibed by Deperiment of Local Govemmenl Finance
INSTRUCTIONS:
To be filed in person o� 6y mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months before June �1 of fhe year the deduction is t��ef�+cOva��7
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to be elfective.
See reverse side for additional instruc6ons and qual�ca6ons. �/j� ,6 �
GIBSON COUNTY AUDiic7n
Applicant (owner o tiact buyer - see 'ctions on reve�se side)
Taxing District Key number / legal description Record nu ber
007- �3
CY � � ,J �� I�_ROO"W�• J � I ��number
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year Mareh 1, current year owner? � Yes � No
7� �a �
If no, what is his / her exad share oi interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that oi applican[, indicate below: Is the property in ques6on:
❑ Real Property � Mobile Home QC E1.1-7)
N�me of mortgagee or contract seller
� , o� ��c�.eco.� C � e���- �, r��� o,�
Address of mortgagee or tract seiler (number and street, city, stafe, ZIP
Name of assignee or oiher owner or holder of mortgage
Address of assignee (number and street, city, state. ZIP code)
Does applicant own propeRy in any other If yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? property for current year? Q Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount oi:
20 20 �i 20 0 20 20 20 20
� Q P
Signature County Auditor Date
I I We certiTy under the penalty oT perjury that the above and foregoing infortnation is W e and cortect and that the applicants was / were
�sident of Indiana and owner oi the aforementioned property on March 1, 20 .
ture (ownefs fufl n e) Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
sident add2 of applicant Address of authorized person
�! , � �/%