HomeMy WebLinkAboutMortgage_KisselFORM 5
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
- FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
t f State Fotm 43709 (R3 / 10-00) � _
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.� Prewibetl by State Boartl of Tan Comrtrissionets _
, NOV 13 200f��eMark
Instructions for fiiing:
To be filed in person or by mail with the County AudRor of the county where the property is�
located during the 12 months before May 11 of the year the dedudion is to be effedive. See��
reverse side for additional insWdions and qualifications. "' GIBSON COUNTY AUDITOR
Applica t(ownerorconVact buyer- see restricH s on reverse side) '
Taxing Distrid Key mber! legal desuiption Record number 1
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/�A Page number
W� —� —
Assess d value of real property as of • Mortgage / Contract indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
� '
If no, what is his / her exad 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:
N--�A of mortgagee or contrad seller � r..
�
Address of mortgagee or contrad setler (number and street, city, state, ZIP _
Name of assignee or other awner or holder of mortgage
Address of assignee (number artd street, dty, state, ZIP code)
Does applicant own real property in any Ii yes, what county? What Taxing Distrid? Has this dedudion been requested on
other county in Indiana? property for wrrent yeaRO Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
9y
zo fla '� zo 0.3 zo Zo 20 �� Zo � Zo ��
� S 4DR �
Signature C1C� � P County Auditor Date
i We ceRify under tFie penalty of perjury that the above and foregoing infortnatlon is We and correG and that the applicants was / were
ident of Indiana and owner of the aforementioned properiy on March 1, 20
i ature (owners full name) Person authorized by duly executed Power of Attomey
� or by IC 61.1-12-.07
Fu resi address of applipnt Address of author¢ed person