HomeMy WebLinkAboutMortgage_BoesQAR,n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i,'"' :-FOR DEDUCTION FROM ASSESSED VALUATION
S / State Form 43709 (R4 f 10-07) �'
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PrescnbeU by DepaNnent ol Local Govemmeni Finance
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INSTRUCTIONS: � g �'File�MaAc ��
To 6e filed in person or by mail with the County Auditor ol the county where the property is located. Q�K 2 8 Z003
Filing Dates: 1) Real Property: During the 12 months before May 11 0l the year the deduction is to 6e eflecfive.
2) Mo6ile Homes assessed under lC 6-1.1-7: Between January 15 and March 31 0/ the year the deduction is to 6e eflectiv�
See reverse side /or addifional instiuctions and qualifrcations.
GIBSON COI�Ji.ITV .
ZUDITOR
(owne�orcontiact buyer- see restrictions on reverse
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Assessed value of real property as of
March 1, current year
no, what is his / her exact
Key number / legal description Record number
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Page number Q � 4�
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MoAgage / ContraU indebtedness unpaid as of Is the applicant the e legal or equitz
March 1, current year owneR es ❑ No
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If name on record is different than thaf of applicanf, indicate below:
Vame of mortgagee or contract seller
� �►�� �q � .��
Address of mprtqaqee or contract sell
If owned with someone olher than spouse, indicate with whom.
(number�andstreet, city, stafe, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand st�eet, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
county in Indiana?
Deduction approved in the amount of:
20
SignaWre
20
COUNTY AUDITOR
20 20 �J� 20
County Auditor
District?
s the property in question:
❑ Real Property ❑ Mobile Home (IC fr1.'
Has this dedudion been requested or
property for current year? 0 Yes 0 N
zo
20 ��
�
I/ We certify under the penalty of perjury that the above and foregoing infortnation is true and correct and that the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20 �.
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Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07 ,
authorized person