HomeMy WebLinkAboutMortgage_Petitjean (2)/e� �°+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
.�J+ Slale Form 43709 (R6 / 5-06)
� Presaibed by Department of Local Gwemment Finante
INSTRUCTIONS:
Count Township Year
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JUN 0 ��di1�f�
To be filed in pe�son o� by mail with the County Audilor of the county where the property is located. �
Filing Dates: 1J Real P�operty: Dunng the 12 months before ,lune f 1 0/ [he year the deduction is to be e��ve. ��
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year e�6e�� �on�s`to be eBective.
See �everse side for additional instructions and qualifications. GIBSON COUNTY AUUa �� ��•
Appliwnt (o er or contracf er - see restrictions on reverse side)
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Taxing Distrid Key'number / legal description ecord number �a , l
C�('�"e� ��3i��oo 00%�o?�'�a ��r
�L/ ' Page number .lo�lO
A ssed value of real property as of Morigage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
M ch 1, curtent year March 1, current year ownef? ❑ Yes ❑ No
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If no, what is his / her exacl share of interest? If owned wilh someone other than spouse, indicale with whom.
If name on record is different than that ot applicani, indicate below: Is the property in question:
_,—,..,__ _. - iome (IC 61.1-�
�me of mortgagee or contract seller �� r �� ����
lll'11YCP 1��.......0� , -
Address of mortgagee or contrad seller (n mber and street, city, state, ZI """
Card \`O . ....................
Name of assignee or other owner or holder of mortgage �/3 �, Q/ ( •
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Address of assignee (number and st�eet, city, state, ZIP code)
Does applipnt own property in any other If yes, what counry? 1Nhat Taxing District? Has this deduction been requested on
county in Indiana? property for curtent year? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 /// 20 �� 20 20 20 20 20
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Signature Counly Auditor Date
We ceAify under lhe penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
resident of Indiana and owner of the aforemenlioned property on March 1, 20
Signatur e/s fuJl.m�iie) Person authorized by duly executed Power of Attomey
� 6��' or by IC 6-1.1-12-.07
Full resident address of applicant ( �A JbS ) a rr Address of aulhorized person
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