HomeMy WebLinkAboutMortgage_Seib (2)`O rt�"° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
° = FOR DEDUCTION FROM ASSESSED VALUATION
�. � Slate FOrtn 43709 (R4 / 10-01)
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� Prescribed by Department of locai Govemmeni Finance
INSTRUCTIONS:
To be filed in person or by mai! with the County Auditor of the county whe2 the property is located. APR � 0�oo�
Filing Dates: 1) Real Property: Dunng the 12 months be/ore May 11 0l the year the deduction is to be effecti e.
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 he year the de tion is to be el/ective.
See ieverse side lor additional instiuctions and qualifications.
GIBSON COUN,Tti' qUD�rna
Applica t( n r or co ct 6uye see stnction o reverse sid ,
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Taxing is rid Key number / legal description Record number �
���y ( ' / �,[{� /^O ��// �v Page number / �
v � \LJ / - (l� / �o
A ssed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
rch t, curtent year March 1, current year owneR ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is diHerent than that of applicant, indicale below: Is the property in question:
❑ Real Property ❑ Mobile Home QC 61.1-�
e of mortgagee or contract seller
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Address ot mortgagee or conlract seller (num er and stieet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for currenl year7 �] Yes� No
COUNTY AUDITOR
Dedudion approved in the amount of:
20 h d 1"�+ A 20 �_ 20 � 20 20 �9 .L 20 �Z 20 '�
� P n
5 o P %�
Sig ture �1 County Auditor Date
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�We certify under the penalty of perjury thal lhe above and foregoing informalion is true and corred and that the applicants was / were
sident of Indiana and owner of the aforementioned property on March 1, 20
Signature owners full name) n _ e Person authorized by duty executed Power of Attomey
��, �� �,�� � or by IC 6-1.1-12-.07
f�resident dress of app nt / � /� Address of authorized person
�. �'02 8� �C � /� �u:6tN� `�� i� "l