HomeMy WebLinkAboutMortgage_Heichelbech� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
? FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
's / Stare Fortn 43709 (RS I 4-03) �� —y
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� PrescnDetl Cy Departmeni ot Local Gtivemment Finance
uvsrRUCr�on,s: SEP 2 6 2003 File Mark
To be filed in person or by mail with the County Auditor of the county whe�e the propert is located.
Filing Dates: 1J Real Property: During the 12 months before May 11 0/ the year the de ction is to e e ctive.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and 2�pJIC�i�aJ�e�e is to be effective.
See reverse side !or additional instructions and qualifications. GIBSON COUN i v,4UDIT0�
ApplicaN
see
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Key number / legal description Record number
����i��RSuWe�+ /�/J—�b���'(�� Pagenumber ga��
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Assessed value of real property as of MoAgage / Contract indebtedness unpaid as of Is the applicant ihe sole legal or equitable
March 1, current year March 1, wrrent year ownefl ❑ Yes ❑ No
no, whal is his / her exact share
If owned with someone other than spouse, indicate with whom.
If name on record is different than ihat of applicani, indicate below:
�ame of mortgagee or contraIX seller
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Address of mortgagee or wntrad seller (number anil street, city, state, ,
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and slreet, city, state, ZIP code)
�/iVA!l�,J l� �. �^stion:
.. J�A I' d rP �!] Mobile Home QC 61.1-�
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b3-8�2��
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Does applicant own property in any other If yes, what county? What Taxing District? I Has this dedudion been requested on
county in Indiana? property for current year? � Yes � No
Deduction approved in the amount of:
20
Signature
COUNTY AUDITOR
20 � I 20 � I 20 _Q� I 20
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County Auditor
20 n 9 ,
P
20
We certify under the penalty of perjury thai the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
(owners lull name)
�- . � .
Person authorized by duly executed Power of Attomey
or by IC 6-7.1-12-.07
addresa �f applicant Y7619 Address of authorized person
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