HomeMy WebLinkAboutMortgage_Breiten�4i �� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�j'l State Fortn 43709 (R6 / SO6)
� Resvibed by Depanmem of Loml Govemmeni Finarrce
INSTRUCTIONS:
To be /iled in person o� by mail with the County Auditor of the county whe�e the property is localed.
Filing Dates: 1) Real Property: During the 12 months before June Il o( lhe year the deduction is to be e�{�iv$. 5 Z���
2J Mobile Homes assessed under IC 6-1.1J: Between January 15 and March 2 0/ the year the deduction is to be eBective.
See reverse side lo� additional instructions and qualitrcations. �"%f� ,Q�
. GIBSON COUNTY AUDITOR
(owner or contract
Taxing Distrid
/ "",✓�'(�
Assessed value of real F
March 1, current year
as of
what is his / her exact share of interesl?
I( name on record is different
of moAgagee or contrad
side) n v
Key number / legal description
a 6- ia-/6-/oo-oos�.
Record number _ _i
Mortgage / Contrad indebtedn s unpaid as of Is the applicant the sole legal or equitable
March 1, current year /Q��QQ owneR ❑ Yes ❑ No
�Innr.r, ��
indicate below:
If owned with someone other lhan spouse, indicate with whom.
Address of mortgagee or contraIX seller (number and street, city, state,
Name of assignee or other owner or holder of mortgage
is the property in question:
❑ Real Property ❑ Mobile Home pC G1.1
r
Address of assignee (numberand stieet, city, state. ZIP code) �� G`r'j'C` 9�u�— -
��t � G/� �
Does applicant own property in any other If yes, what county? What �P� � sted on
county in Indiana? �wl� es❑ No
"V ���0 (
COUNTY AUDIl un
Deduction approved in the amount of:
20 �_ 20
Q
Signature
20 20 �
County Auditor
20
Date
�
We certify under the penalty of peryury that the above and foregoing infortnation is true and correct and that the applicants was / were
�esidenl of Indiana and owner of the aforemenlioned properfy on March t, 20
Person authorized by duly exewted Power of Attorney
or by IC 6-1.1-12-.07
of authorized person
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