HomeMy WebLinkAboutMortgage_Oldsie'�"�q. STATEMENT OF MORTGAGE OR CONTRACT INUEBTEDNESS
'+` = FOR.DEDUCTION FROM ASSESSED VALUATION Count Township Year
-- -J 51ate Form 43709 (R615-O6) . • . .
�,�� Resaihed by Department ot laal Govemment Finance
INSTRUCTIONS: File Mark
To 6e frled in person o� by mail wdh the County Auditor of the county where the p�opeRy is located. OC r 2 20�%
Filing Dates: iJ Real P�operty: During the 12 months before June Il oI the year the deduction is to be e((ective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0( the y�d�qn is to be elfective.
See reverse side for additional insUuctions and qualifications. GIBSON C0� TY UDITOR
contr�cf byNer- see restycyops or reverse side)
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Taxing Distrid // Key number / legal description Record number
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Assessed value of real property as of MoAgage 1 Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, curtent year March 1, current year owner? ❑ Yes ❑ No
�o, a��,
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is difterent than that of applicant, indicate below:
�me of mortgagee or conUad selier �. ,.
Address of mortpagee w coMrad seller (number� street, city, state, ZIP
Name of auignee or
Address of
or holder of mortgage
sLeet, aty. state, ZIP code)
Does applicant own property in any other I I( yes, what county?
county in Indiana?
Deduction approved in the amounf of:
zo� za� zo
Q p
Signature
20
County Auditor
We certify under the penalty of peryury that the above and fore�
lesident of Indiana and owner of the aforementioned property c
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sthe property
❑ Real Properfy ❑ Mobile Hane pC S1.
� 77 �7 S SR � �
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of by IC 6-�.�i-._ ..
m resiaent aaares�� app�ican[ Address of authorized pe�wn
1777 S SR 57 (���'lanrn ('/Yu �1��_U%�n�nf 1
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