HomeMy WebLinkAboutMortgage_Marioni�� 4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
:� w� ,i' State Fortn 43709 (R6 / 5-06)
i� Presaibed by Department of Local Gmemment Finance -q� �
1'1
INSTRUCTIONS: File Mark
To be filed in person or by mail with the CountyAudito� of the county where the propeRy is lo��l. 1 9 Z��$
Filing Dates: 1J Real Property: During lhe 12 months before June Il o/ the year the deduction is lo be eflective.
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2��a� .,i�l�.duc6on is to be elfective.
See reverse side for additional instiuctions and qualifications. GIBSON COUNT AUDITOR
Applicant (owner
Taxing
see re�triStipqfi �n reverse side)
Key �umber / le�al description � I Record number O
l,l� I oC lD -I I� I 3 ��W � � rT Pa number a��
TV
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, current year March 1, currenl year owneR ❑ Yes ❑ No
SSOOc7
If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
name on record is difterent Ihan ihat of applicant,
of mortgagee or conVad seller
of mortgagee or conVad selier (number and street, dry, state, ZIP
or other owner or holder of mortgage
of assignee (num6er and sheet, city, state, ZIP code)
Dces appliwnt own property in any other I If yes, what county? What Taxing Distrid?
county in Indiana?
�OO`� ' dI0 � COUNTYAUDITOR
�
Dedc�l':l�\'�C \0 .............. .... �
20 CSI'(1 \0 . ....................
Signature
20
County Auditor
�
� ��T-
s t e pt1 roperty in
❑ Real Property ❑ Mobile Home (IC 61.1-n
Has this deduIXion been requested on
property for curtent yea(? � Yes ❑ No
20
20
certify under the penalty of perjury lhal lhe above and foregoing informalion is true and corted and that the appticants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly exewted Power of Attomey
or by IC 6-1.1-12-.07
�u rescem a ress or appu nz naaress or aumonzea pereon
�P�/ 3 °�.cd n(�/i ��.Oi�