HomeMy WebLinkAboutMortgage_Vanmeter� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�. �w� ' ♦ State fortn 43709 (RS / 4-03)
PmsaibeG by Department of Lotal Govemment Financa
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INSTRUCTIONS: SEP 2 ������
To be filed in person or by mail with fhe County Audifor of the counry where the property is located.
Filing Dates: 1) Real Property: During the 12 months before May 11 0/ the year the deduction is t e eflective
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o/t r is to e e ctive.
See reverse side for additional insfructions and qualifications. � r, GIBSON OU T Y hUDiTOR
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Applicant� aero0contraj.i nuye'r, see r,esjnciw��, �,� ���.,,, _.,.__, /�
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Key number / legal description Record number
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Assessed value of real property as
March t, curcent year
no, what is his / her exad share of interest?
MoAgage / ContraG indebtedness unpaid as of Is lhe applipnt the sole legal or equitable
March 1, current year ownef? ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
If name on record is difterent than that of applicant, indicate below:
�vme of mortgagee or contract seller �
Address of mortgagee or contract seller (numb a�ieef, ciry, state, ZIP
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 olher If yes, what counry?
county in Indiana?
Deduction approved in the amounl of:
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What l
COUNTY AUDIT(
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County Auditor
❑ Real Propsty ❑ Mobile Home (IC G1.1
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We certify under the penalry of perjury that the above and foregoing infortnation is true and corred and lhat ihe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
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Person authorized by duly executed Power
or by IC 6-1.1-12-.07
of applicant „, , �Address of authorized person