HomeMy WebLinkAboutMortgage_Preske%°a 4 STATEMENT OF MORTGAGE OR CONTRACT IN�E6TEONESS
`i�..: `= FOR DEDUCTION FROM ASSESSED VALUATION ,;
/ State Form 43709 (R6 / SO6)
� Presaibed by Department of Local Gwemment Finance
INSTRUCTIONS:
To be filed in pe�son or by mail with the County Auditor of the county whe�e the propeRy is located . ., .
Filing Dates: 1) Real Property: Dunng the 12 months before ,lune Il o/ the year the deduction is.to be eliecti ) (I
2) Mobile Homes assessed under IC 6-1JJ: Between January 15 and March 2 0( the year the deducG�nSis %u5e effective.
See �everse side /or additional instructions and qualifications. �� ��
� • �GIBSON COUNTY AUDITOR
Applipnl
Distrid
Asseb�ed value of real propertylSs of
March 1, curtent year
If no, what is his / her exact share of interesl?
side)
Key number / legal description Record number ��
r�/ — n_�a—IOI��. �_ Pa en mber ���J
(�lD `1
MoAgage / Contrad indebtedness unpaid as of Is ihe applicant the sole legal or equitable
March cunent year owneR '` � Yes � No '
� V
If owned with someone other than spouse, indicate with whom.
If name an record is different than that of applicant, indicate below:
�e of moAgagee or contrad seller
I��I1
Address of mortgagee or contrad seller (number and street, city, state, ZIP
assignee or other owner or holder of mortgage
of assignee (num6erand st�eet,
ZIP code)
Does applicant own property in any other I I( yes, what county? What Taxing Dislrid?
county in Indiana?
�OUNTY AUDITOR
� ��1"1111'CI' �i0. �.t.�..!. �;"!�, I
20 �_ C:l i' � �' Q. . . . . . . . . .. . 20 20
D..........
1
Signature
County Auditor
Is the property in question:
❑ Rea� PropeAy ❑ Mobile Home
� Vl� �W l.A..�
9
1
Has this deduction been requested on
property for wnent yea(? � Yes ❑ No
20
20
We certify under the penalty of perjury that the above and foregoing informalion is true and corred and that the applicants was / were
esident of Indiana and owner of the aforemenlioned property on March 1, 20
Signature (owners lull name) Person authorized by duly executed Power of Attomey
�j �.� � �. /.) _ „ Q or by IC 6-1.1-12-.07
rmi resWeui .etltlress ot applicant Address of authorized person
� S9 y f, c is 6.cis/o�tn t �