HomeMy WebLinkAboutMortgage_Beasley (2)'�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i` � FOR DEDUCTION FROM ASSESSED VALUATION
��j+ StateForm43709 (R6/5-06)
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� Prescribed by Department of Local Gwemment Firence
INSTRUCTIONS:
Coun Township Year
FEB 1 26�Mark
To be filed in person or by mail with the County Auditor of the county whe�e fhe p�operty is located.
Frling Dates: 7) Real Property: During the 12 months 6efore ,lune � 1 0/ the year the deduction is to be e ective.
- 2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and Maich 2 ot the yg�� is to 6e eflective.
See reverse side fo� additional instnictlons and qual�cations. GIBSON COUN7Y AUDITOR
Applicant (own � r tracf buyer- see res ons on reve e ide)
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Taxing Disirid Key number / I g I description cord number ^� �
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Page number
�6-,i-� - 00-«�3. o oa % � o� �f
Assessed value of real pr rty as of MoRgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, curtent year March 1, curtent year ownef� �es ❑ No
a oo �
If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is dif(ereni ihan Ihat of applicant, indicate below: Is the property in question:
eal Property ❑ Mobile Home QC 61.1-�
�e of mortgagee or contrad seller
Address of mortgagee or contrad seller ( umber and st�, city, sfate, ZIP _77� �
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Name of assignee or other owner or holder of mortgage , r� •'-
��a�,e< � � • ��
Address of assignee (num6er and stieet, city, state, ZIP code) `O'. ,.`' �^ Q � � O
Ca'�a '� ��U �
Dces applicant own property in any other Ii yes, what counry? Wh; '�q, _,nis dedudion been requesled on
county in Indiana? �U(,� � property for curtent yea(? � Yes ❑ No
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� COUNTYAUDITOR �� / /�J/9
Deduction approved in the amounl of:
20 �_ 20 �_ 20 20 20 20 20
P P
Signature County Audftor Dale
We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
sident of Indiana and owner of the aforementioned property on Marrh 1, 20
Signature wners 1 name) Person authorized by duly executed Power of Attomey
A or by IC 6-1.1-12-.07
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Full r sident address of applicant Address of authorized person
7 S. �u� � L�t ,
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