HomeMy WebLinkAboutMortgage_Powers (2)���� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (R5 / a-03)
� Prescribetl Cy Department o1 Loral Govemment Financa
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t � s ��'
INSTRUCTIONS: NOV FU��3
To be filed in person or by mail with the County Auditor ot the counfy where the propeRy is located.
Filing Dates: 1) Real Property: Dunng the 12 months before May 11 of the year the deduction is to be e/fective. �
2) Mobiie Homes assessed under fC 6-1.1-7: Between January 15 and March 2 of the year�the dedu�ti ��is�to be e8ed�e.
See reverse side for additional instructions and qualifications. ��GiBSON C�OUNT Y q�p�q�
a�o -► 3-�3 - � o � 6� ��s �c�
Applicant (�ne�or contract 6uyer - see ctions on e side)
6 i
Assessed value of real property as
March 1, current year
no, whal is his / her exacl share of interest?
Key number / legal des on
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Mortgage / Contract inde dness unF
March 1, current yea�2�'��
o'
If name on record is different than that of applicant, indicate below:
of mortgagee or contract seller
Address of mortgagee or wntrect seller (number and
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
counry in Indiana?
20
%'Y"Raa,e-
Signature
in the amount of:
20 20 �_
V //
IRecord number O �
Page number � ^/
�7.
as of Is the applicant the sole legal or equitable
owner? ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
ZIP
VJF
COUNTY AUC
20� 7
r
County Auditor
s the property in question:
❑ Real PropeAy ❑ Mobile Home (IC 61.1-7)
���-- `
-- 03-��'3�.!
Drawer N� .............
Card N� . .....................
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P
20 _Q'L 20
P
�ate
quested on
� Yes ❑ No
certify under the penalty of perjury that the above and foregoing information is true and cortect and that the applicants was I were
lent of Indiana and owner of the aforementioned property on March 1, 20
�re.(ewner,s (ull yarpe , Person authorized by duty executed Power of Attomey
or by IC E1.1-12-.07
of authorized person
!