HomeMy WebLinkAboutMortgage_LuigsR�' � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'- : FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S -'/ S�ate Fofm 43709 (R4 / 10.01)
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Prescribed by DeDanmenl ai Local Govemment Finance
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�NSrRUCnoNS: MAR 17F�f1�'3`k
To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real PropeRy: Donng the 12 months 6e%re May 11 0/ the year the deduction is --be e(/ective. �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 o e yea ,the ed ion is � b eflective.
See reverse side for additional instructions and qualifrcations. ' GIBSON COUhT Y aUDiT�
Applicant (owner or " nf ct buyer - see s on reverse ide)
Taxing Distrid ey numb / Iegai description Record numbe� ^
/ / CJ P
/v� / L� �/� _ � (� Page number ��j�
�J� / ��
Assessed value of real properiy as of MoRgag"�e Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year MarcFy�A,rrent year �D owner? ❑ Yes ❑ No
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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 diHereni ihan that of applicant, indicate betow: Is the property in question:
❑ Real Property ❑ Mobife Home pC 61.1-�
�ame of mortgagee or contrad seller �
Address of mortgagee or contract seller (number a street, city, state, ZIP
Name of assignee or other owner or holder of mortgage --
Address of assignee (number and sfreet, city, state, ZIP code) T ••••��/�
Dra��er ti�••�� ^
Does applipnt own property in any other If yes, what county? What Te T •••••• �sted on
1�. ........
county in Indiana? Card ""' �� es❑ No
COUNTY AUDITOR
Dedudion approved in the amouni of:
20 Q,� 20 20 �, h 20 �� 20 �� 20 �� 20
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Signature County Audftor Date
�/ We certify under lhe penalty of perjury that the above and foregoing infortnation is true and correcl and thal the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
Si ature (owners lull name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
ull resident address of applica t Address of authorized person
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