HomeMy WebLinkAboutMortgage_WhiteheadSTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
t / State Fortn 43709 (R4 / 70-07)
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� Prescribe0 Cy Department of Lotal Govemment Finance � �
INSTRUCTIONS: APR ��'� ^�83
To be filed in person or by mail with the County Auditor ol [he county whe2 the property is located.
Filing Dates: 1) Real Property: During the 12 months before May 11 0/ the year the deduction is to eflec6ve.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 of th ear the�uction is to be eHective.
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See reverse side Ior additional instructions and qualifrcations. GIBSON COUNTY nUDi70R
Appl' nt ( er tract buyer - see sfricti ns o rev e'de)
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Taxing D' trid Key number / legal descriplion Record number Q�
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A ssed value af real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, currenl year owneR ❑ Yes � No
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li no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mob7e Home QC 61.1-�
�ame of mortgagee or contrad selier �� —
Drawer NO..�,�_,
Address of mortgagee or conVact seller (nu er and st2et, aty, state, ZIP . •^��
Name of assignee or other owner or holder of mortgage Card NO: .
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Address of assignee (number and stieet, city, state, ZIP code)
Does applicant own propeAy in any other If yes, what wunty? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for current yeaf? 0 Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 a 20 � 20 �,Z 20 �� 20 Q�
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Signature County Auditor Date
I/ We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Si nature (owners full name) 7 Person authorized by duly executed Power of Attomey
�. � �� /,/ iL� or by IC 6-1.1-12-.07
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Full resident address of applipnt Address of authorized person
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