HomeMy WebLinkAboutMortgage_Boarman�v` "� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�i� M: ;= FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
>� y State Fwm 43709 (R6 / 546)
� Presaibed by Department of Lwal Govemment Finance
To beR eC�TIOP Sson or by mail wrth the County Auditor of the county where tbe property is located� .I �JFiI¢�dart��
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Filing Dates: 1) Real Property: Dunng the 12 months before June I1 0( the year the deduction is to 6e eBective.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year tF��fe�c�or��tP be effective.
See reverse srde for additional instiuctions and quali(ications.
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Applicant (owneror ract buyer- see restri ' ns on reverse side) GIBSON CpUtJTY AUDITOR
Taxing Distrid Key number / legal description Record number
("� _ ? _ 3 Page number � �
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, wrrgnt year owneR ❑ Yes ❑ No
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If no, what is his / her exad share of inte�esl? If owned wilh someone other than spouse, indicate with whom.
If name on record is different lhan lhal of applicant, indicate below: Is the property in question:
❑ Reai Roperty ❑ Mobile Home pC 61.1-�
me of mortgagee or contraG seller /� ��
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Address of mortgagee or contrad seller (number and stieet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sfreet, city, state, ZIP code)
Dces applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for wrrent year? � Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �� 20 20 �_ 20 20 20 20
P P p .
Signature County Auditor Date
�� We certify under the penalty of perjury lhat the above and foregoing informalion is true and corred and that the applicanls was / were
. resident of Indiana and owner'of the aforementioned property on March 1, 20
Si nal (o ers /ul ame) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
�F II resident addres of applicant Address of authorized person
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