HomeMy WebLinkAboutMortgage_Kerni��� STATEMENT OF MORTGAGE OR CONTRACT INGEBTEDNESS
°�i' ; FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
«. 2 Siate Form 43709 lR6/5-06)
� Prescnbed by Depariment of Lotal Govemment Finance
wsrRUCnoNS: AUG 3 0 2Q�1� ^^a�`
To 6e filed in person o� by mail wrth the County Auditoi of the counfy where the property is /ocated.
Filing Dates: 1) Real P�operty: Dunng the 12 months before June 11 of the year the deduction�is to� f„fective/.1�/�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the y�fAe�i2ei(�[iSn is to be eflective.
See reverse side for additional instructions and quali�cations. GIBSON COUNTY AUDITOR
Applicanl er or contract buy,er- see trictions o reverse side)
� , /�
Taxin rid Key ber / legal description Record number
� � �3 � � 3�v 000.�a oa
�, �� Page number �
A ssed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
arch 1, curtent year March 1, current year owneR ❑ Yes ❑ No "
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: _ J� ��—:
�me of mortgagee or contrad seller a�� . pC 61.1-�
� �ra��'er�0•.........•
Address of mortgagee or contract seller (numb and street, city, state, ZIP 5a5q• ••�"'
� ' � : „ . . . Card��� �3p 0�•
,
Name of assignee or other owner or holder of mortgage
Address of assignee (num6erand street, city, sfate, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for current year? Q Yes � No
COUNTY AUDITOR
Deduction approved in the amounl of:
20� 20 Q'� 20 20 20 20 20
/
Signature County Auditor Dale
� We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
'esideni of Indiana and owner of the aforementioned property on March 1, 20
� Signature (owners full name) Person authorized by duly executed Power of Attomey
� � or by IC 6-1.1-12-.07
Full re iden ddress of app icant J Address of authorized person
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