HomeMy WebLinkAboutMortgage_Richter� n FORM 5
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Filin fee 51.00
�-' _� FOR DEDUCTION FROM ASSESSED VALUATION 9
_ r Coun Township Year
'y J State Form 43709 (R / 12-99) �,. -,
PreSaibed by Slale Board ol Tax Commis5i0ners q q
� • • lLJ
MAR 12 ��lra`k
InsVuctians for filing:
To be filed in person or by mail with the County Auditor of the county where the property is
located during the 12 months before May 11 of lhe year the deduction is to be effective. See
reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Applicant
Taxing
or contract 6uyer-,see ;estnc`ipns on reverse
Key number / legal description
number
U
D��/-n0377 � Pagenumber
7 �.�
A essed value of real propeRy as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, curr year ���� �Sa �� owneR ❑ Yes ❑ No
�aooa
If no, what is his / her exact share of interest? I owned with someone other than spouse, indicate with whom.
name on record is different than that of applicant, indicate below:
of moRgagee or contrad seller 4[�//�l % ,�/
�% (. V w� %(
Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder o( moRgage
and streef, city, state, ZIP code)
Does applicant own real property in any If yes, what county? What Taxing District? Has this deduction been requested on
other county in Indiana? propeRy for current yeaf? � Yes� No
PROPERTY TAX ASSESSMENT BOARD OF APPEALS
20�_ 20�
v[ /_-11' °� In'
Signature
amount of:
' b i-
20
20
,A /
Secrelary of PTABOA
20
20
Date �LO 6
O
20 �
P
�9 _ /,
/ We certify under the penalty of peryury that lhe above and foregoing information is true and corred and lhat the applicanls was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
ature owners lull name)
F-
esiden ddr of applican
/l Rl BO� /l3 NAU�S
� 713
Person authorized by duly executed
or by IC 6-1.1-12-.07
of authorized person