HomeMy WebLinkAboutMortgage_Davis�'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
- ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�. ' � S�ate Fortn 43709 (R4l 10-01)
w. —'9 �
� PrescriDetl by Depanment of Local Govemment Finance � 3 'y`-�; �!� \
1 '7-1 H 7
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INSTRUCTIONS: �UL iFj MeFk,
To be filed in person or by mail with the County Auditor o/ the county where the property is located. �UU3
Filing Dates: 1) Real Property: Dunng fhe 12 months before May 11 0/ the year the deduction is to�e eNective. � �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 0/ the ye r the d�� ction is to 6e eNective.
�
See reverse side for additional instructions and quali�ca6ons. �'�GIBSON COUNTr q�iDITOR
Taxing
contrdct buyer- see
�ed value of real property as
1, current year
If no, what is his / her exacl share of interest?
name on record is
mortgagee or contrad seller
J
Key number / legal description Record number O�
%�'�,(.JJ O/O.�% � Page number / //� �
lN / / c7�U ���
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year ownef? ❑ Yes ❑ No
Address of moRgagee or contrad seller (number and
Name of assignee or other owner or holder of mortgage
Address o( assignee (number and sfreet, city, sfate, ZIP code)
Does applicant own property in any other If yes, what counry?
county in Indiana?
Deduction approved in the amount of:
�/L�'�
I(
state, ZIP
with someone other than spouse, indicate with whom.
What T
COUNTY AUDIT
20 F% �i 20 �
p I
i
County Auditor
❑ Real
question:
❑ Mobile H«ne pC 61.
�r
(�Av-�-� . --
G2�Gv/Ly �-
mrcr�-c;�c� �
03 - �/J� ��
20 ��
20 ��
�
Date
zo
ed on
;� No
/ We certify under the penalty of peryury that 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
Person authorized by duly executed Power o( Attomey
or by IC 6-1.1-12-.07
Full resident addres�f applipnt Address of authorized person
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