HomeMy WebLinkAboutMortgage_Rosenberger��"° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
- � FOR DEDUCTION FROM ASSESSED VALUATION
S � State Fwm 43709 (R4/ 10-01)
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� PresaibM by DeDartment of Lofal Govemmeni Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor o! the county where the propeRy is located. �e�
Filing Dates: 1) Real Property: Dunng the 12 months belo�e May 11 0l the year the deduction is to be eSearNB!� Q 3 2��3
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and Maich 31 0/ the year the deduction�is to be e/%ctive.
See reverse side (or additional instrucfions and quali�cafions. � �� �,; r�� �
�Y"""_"-������Y,al.'DITOR �
GIBSON COt,�
Applicant (owner o contrac yer see s orjT�verse side)
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Tauing Distrid Key number / legal description Record number g a
V
� Q L' /� ^ � Page number
7
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March i, current year March 1, current year owne(? ❑ Yes ❑ No
/,5d OOd
If no, what is his / her exacl share of interesl? Ii owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicani, indicate below: Is the property in queslion:
❑ Real Property ❑ Mobile Hane (IC G1.1-�
��ame of mortgagee or conVact seller
Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, slate, ZIP code) 1
Does applicant own property in any other If yes, what wunty? What Taxing District? Has this dedudion been requested on
county in Indiana? property for current year? � Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
za � zo � zo zo � zo _Q.� zo �$_ zo 0 9
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Signature Counfy Auditor Date
I/ We certify under the penalty of perjury lhat the above and foregoing infortnation is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
'g ture (owner's full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
F II resident address of applipnt Address of authorized person