HomeMy WebLinkAboutMortgage_Chandler� ar R j STATEMENT OF MORTGAGE OR CONTRACT INt7E8TEDNESS
's.'� FOR DEDUCTION FROM ASSESSED VALUATION ,
'_ w. J Stata Form 43709 (R6 / 5�06) � . .
� Presaihed by Department ot Laal Govemmant Finance
INSTRUCTIONS:
Count Township Year
rile �lark
To be tiled in person or by mail wdh the CountyAuditor of fhe county whe�e the property is located. �T � Z���
Filing Dates: 1J Real Property: Ouring the 12 months before ,lune 11 0/ the year the deduction is to be E�v .
2) Mobile Homes assessed unde� IC 6-i.1-7: Between January 15 and March 2 o(the yea� t�deductjpp�is to 6e e8ective.
p,��,CS�.
See reverse side for additional instruc6ons and qualifications. (/
� GIBSON COUNTY AUDITOR
Applicant
Taxing Distrid
value of real property as af
March 1, curtent year
no, what is his / her exad ahare of interest?
If name on
Key number / f�gal desuiption
a�-aa-o/3o�ro-�
Mortgage / Contrad indebtedness unpaid as
March 1, curtent year �
that of applicant,
of moAgagee w conVad seller
Address of moAgagee a contrad seller (number an
Name of assignee a other owner w holder of moAgage
Address of assignee
Dces appliprrt own
munry in Indiana?
Deduction approved
20 �_
Signature
Record number ,r , / D �
.��j' f
�-iJCJ��er �.�9
Is the applicant the sole legal or
owneR ❑ Yes ❑ No'
I! If owned with someone other than spouse, indicate with whom.
j�.�) �eA� � oerty in quesUon:
C� r`^' O� ��� J mpeAy ❑ Mod1e Hane (IC 61.1-�
"JANUE L
intl st2et city, state, ZIP code)
arry other If yes, what wunry?
03-S�iti+3
What Taxing Distrid?
COUNTY AUDITOR
the amount of:
20 20 20
�
County Auditor
Has lhis dedudion been requested on
property for current yea(?� Yes� No
20
Date
20
We certify under the penalty af perjury Uiat the above and foregoing information is true and corred and ihat ihe applicants was / were
esident of Indiana and owner of the aforemenlioned property on March 1, 20
Person aulhorized by duty exewted Power of Attomey
or by IC 6-1.1-12-.07
Address ot authorized person