HomeMy WebLinkAboutMortgage_Jost (5)��STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
�FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
• State Fortn 43709 (R6 / 5-06) � � ��
��� Rescribed by Department of Loral Gwemment Finance
. � r.-
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INSTRUCTIONS: MAR 2 4F���}M6�
To be filed in person o� by mail with the County Audito� of the county whe�e lhe p�opeRy is located.
Filing Dates: 1) Real P�operty: Dunng the 12 months before `,lune I7 0l the year the deduction is to be ve.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the yea �r�et'�ds to be eRective.
See reverse side for additional instructions and qualifications. G�BSON COUNTY UC:TOq
Applicant (own�or contract buyer -
/�Q.GI
reverse side)
/ legal description
Assessed vatue of real property as of Mortgage / Contrad ii
March 1, curtent year March 1, current year
If no, what is his / her exact sbare of interesl?
If name on record is difterent than that of applicant, indicate below:
of moRgagee or contraU seller
Address of mortgagee or contract selier (number and street,
Name of assignee or other owner or holder of mortgage
number
Page
unpaid as of Is the applicant the sole legal or
owneR ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
ZIP
Ad� LIP code)
Doe Dra�v�l' 1�'�. c,{. �, -�%�s d counry? What Taxing Distrid?
COL' •
�
Card NO . .....................
COUNTY AUDITOR
DeducGon approved in the amouni of:
20
Signature
zo ov 2o I2o 20
P
County Auditor
Is the property in question:
❑ Real Property ❑ Mobile Home
Has this deduction been requested on
property for current yea(? � Yes ❑ No
�
Date
zo
certify under the penalty of peryury that the above and foregoing information is lrue and corred and that the applicants was / were
lenl of Indiana and owner of the aforementioned property on March 1, 20
Signa re (o ners lull name)
� � �- (
Full residenl address of ap '
I �` � � `( So.,�� W�e
f . Z'v
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person