HomeMy WebLinkAboutMortgage_AlveydArt•n � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
`# ' : FOR DEDUCTION FROM ASSESSED VALUATION
�� y State Form 43709 (R4l 10-01)
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` Prescribe0 by DeOaMent of Local Govemment Finance
INSTRUCTIONS:
To 6e �led in person or by mail with the County Auditor o/ the county where the property is located. ftr T 1R 2�02
Filing Dates: 1) Real PropeRy: During the 12 months 6e/ore May 17 of the year the deduction is ro be eF/ct6ve�
2) Mo6ile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0/ th'�e� year the d/eductron is tq/�be Nective.
See reverse side Ior additional instiuctions and qualifications. /�/ �--��, J�'`'."�6-�'�/
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GIBSON COU`i?? :J61TOR I
Applicant ( w er orcontrac uyer- s estnctions on revers i) .
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Taxing ' trid � Key number / legal descrip n Rewrd number
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I r`Al ��(j�J_ O���—� Page number
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Ass sed value of real property as of MoRgage / Contract indebtedness unpaid as of Is the applicant the sole Iegai or equitable
Ma ch 1, current year March 1, current year owner? ❑ Yes ❑ No
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If no, what is his / her exact share of inlerest? If owned with someone olher than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Properfy ❑ Mobile Home (IC 61.1-�
�ame of mortgagee or contraU seller
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Address of morigagee or contracl seller (numb and street, city, slate, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st�eet, city, state, ZIP code)
Does applicant own property in any other It yes, what county? What Taxing Districl? Has this deduction been requested on
county in Indiana? property for current year?� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
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Signature County Auditor Date
�I / We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
, a resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners /ull name) Person authurized by duly executed Power of Attorney
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or by IC 6-1.1-12-.07
Full resident atldress of applicant Address of authorized person
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