HomeMy WebLinkAboutMortgage_Hipp (2)STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
- ' FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
S p�� / State Form 43709 (R4/ 10-01) � ��
�, Prescribe0 by Deparimen� of Local Gavemment Finance
INSTRUCTIONS: D E C F`� ��) UZ
To be filed in person or by mail with the County Auditor ol the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months be%ie May 11 o/the year the deduction is to be ectrve
2) Mo6ils Homes assessed under IC 6-1.1-7: Between January 15 and March 31 of the. r tive.
� GIBSON OUNTY hUDI , 1
See reverse side for additional instructions and qualifrca6ons.
Applica vmer or contract e- see restnctions on e side)
Taxi istrid Key numbe / I gal description Record number ��
f.Yl/�L,�� /%6 .2_�O Pagenumber ��
�.?�J T 'l c.J
A ssed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
ch 1, current year March 1, current year owne(? ❑ Yes ❑ No
V
If no, what is his / her exad share of interest? owned with someone other than spouse, indicale with whom.
If name on record is difterent lhan ihat of applicant, indicate betow: Is the property in question:
� Real Properly ❑ Mobile Home pC 61.1-�
�me of mortgagee or contract seller .
Address of mortgagee or conVaIX seller (number and sheet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Taxing Distrid? Has this deduIXion been requested on
county in Indiana? property for current yeaR � Yes � No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �� 20 20 _� 20 � 20 O% 20 20 �
P �
Signature County Audftor Date
We certify under the penalty of peryury lhal Ihe above and foregoing infortnation is true and corred and that the applicants was / were
, resideni of Indiana and owner of the aforementioned property on March 1, 20
Signature (owne/s (ull name) Person aulhorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
Full sident address of applipnl Address of authorized person
i2 #Z l�3ox C
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