HomeMy WebLinkAboutMortgage_BowersSTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
-- � FOR DEDUCTION FROM ASSESSED VALUATION
S J Slate Fofm 43709 (R4 / 10-Ot )
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� PrescribeA by DepaNrenl ot Local Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor ol the county whe2 the property is /ocated. D E C� 2�Q2
Filing Dafes: 1) Real Property: During the 12 months befo2 May 11 0l the year the deduction is to be e(/ective.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 of t year the de uc ' �s fo be el/ ctive.
See reverse side /or addftional instnic6ons and qualifrca6ons.
� GIBSO�'�' OU TY AUDITOP,
Appli t(o erorcont bu er- see tnctions on reverse side)
Taxing D' trid n Key number / legal descriplion Record number O^
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Page number �
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Ass ed value of real properly as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
Mar 1, current year March 1, current year owneR ❑ Yes ❑ No
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If no, what is his / her exact share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is dif(erent than that of appiicant, indicate below: Is the property in question:
❑ Real Prope�ty ❑ Mobile Hane (IC 61.1-�
�me of moRgagee or contract selier � /�
Address of mortgagee or wntrad selier (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and st2et, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Ta�cing District? Has this deduction been requested on
county in Indiana? property for curtent year? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
zo zo 0 20 _(� 2o O, zo 0 7 zo Q� 20 _�_
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Signature County Aud'Aor Date
�/ We certify under the penalry of perjury that the above and foregoing information is irue and corred and lhal lhe applicants was / were
. residenl of Indiana and owner of the aforementioned property on March 1, 20
Signature wners full na �� Person authorized by duly executed Power of Attomey
Xor by IC 6-1.1-12-.07
Fu I sident address of applipnt Address of authorized person
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