HomeMy WebLinkAboutMortgage_Lambert (2)`° rt'"° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
S•� J Slate Fofm 43709 (R4 / 70-01)
�� Prewibed by Department ot Local Govemment Finance �
INSTRUCTIONS: File Mark
To be filed in person or 6y mail with the County Auditor ol the county whe2 the property is locat�f � 2 R Z0�2
Filing Dates: 1) Real P�opeRy: During the 12 months 6efore May 11 of the year the deduction is to be eflective.
2) Mobile Homes assessed under IC 6-1.7J: Between January 15 and Marc 1 ot the ye th�� tion is-fo be eHective.
See reverse side lor additional instructions and qualificafions. {/t��
GIBSON COUNTY AUDITOR I
Applicant (owner or cont t uyer- see tric ' s on re rse side)
Taxing Disirict Key number / legal description Record number O�
/-� / _ �� � � T Page number �� �
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ssessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, wr�nt year owne(? ❑ Yes ❑ No
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�� 30 O
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is difterent than Ihat of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home QC 61.7-�
�e of mortgagee or contract seller �
Address of mortgagee or contract seller (number and stre t, 'ty, state, ZIP
Name of assignee or olher owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Does applipnf own property in any other If yes, what county? What Taxing Distrid? Has lhis deduction been requested on
county in Indiana? property for current yeaR � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amounl of:
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Signature County Auditor Date
�We certify under the penalty of perjury that the above and foregoing infortnation is true and correct and ihat the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
' nature (ow ers (ull name� (������ �YN' Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
Fulljegident address of applicant Address of authorized person
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