HomeMy WebLinkAboutMortgage_Elpers (9)rt� , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-- : FOR DEDUCTION FROM ASSESSED VALUATION
•> , Sfate Form d3709 (R / 72-99)
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�Prescribed by State Board of Tax Commissfoners
�
FORM 5
Filing fee 51.00
Coun Township Year
� � � �
FEB 2 �''2�`'`
InsVuctions for filing:
To be filed in person or by mail with the County Auditor of the county where the property is
located during the 12 months before May 11 of the year the deduction is to be effedive. See
reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Applicant
see r�nqtjons on reverse side) , ,� _
� �"� v
Assessed value of real property as of
March 1, current year
If no, what is his / her exact share of interest?
If name on
/legaldescription
i���'����.5"�
March 1, current year
than lhat of applicant, indicate
of mortgagee or contrad
Address of moRgagee or contract seller (num�er and st2et,
Name of assignee or other owner or holder of mortgage
as of I Is lhe a
,owner?
u
the sole legal or
❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
state, ZIP
Address of assignee (num6er and street, city, state, ZIP code)
Does applicant own real property in any If yes, what county? What Taxing District? Has this deduction been requested on
other county in Indiana? property for current yeaf? ❑ Yes� No
PROPERTY TAX ASSESSMENT BOARD OF APPEALS
Deduction approved in the amount of:
20
l., ��,-�� I ��-
20 �3 _
20 �
'�
Seaetary of PTABOA
20
�
20 � n
r� r' �
� �
I/ We ceRify under the penalty of perjury lhat the above and foregoing in(ormation is true and corred and that the applicants was / were
� resident of Indiana and owner of the aforementioned property on March 1, 20
(owne/s /ull name)
Person authorized by
or by IC 6-1.1-12-.07
person