HomeMy WebLinkAboutMortgage_Burch� ��� � STATEMENT OF MORTGAGE OR CONTRACT IN�EBTEDNESS
' " FOR DEDUCTION FROM ASSESSED VALUATION Coun Tawnship Year
. �w� / Slate Fmm 43709 (R6! 5-06)
• Aesaibetl by Departmerri of local Gwemment Finance ;-r si ----{
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INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Audrtor ol the county where the property is located. S E P 2 4 ZQQ]
Filing Dates: 1) Real PropeRy: During the 12 months be%ie �une 17 of the year the deduction is to be eflective.
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 o(the year the tl�dact_ion �t�g eifective.
O'/� r"�
See reverse side /or additional instructions and qual�cations. pIBSON COUNTY AUDITOR
Taxing
restridions on reverse side)
Key number / legal description Record number � v a
��1.��.1.1/ G- OS-.3/ _G�D� '�QD, �d 7 Page number 3� i q
Asseued value of ma� property as of MoAgage / Contred indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, current year owne(t ❑ Yes ❑ No
� a�0��
If no, what is his ! her exad ehare of interest? If owned with someone olher than spouse, indicate with whom.
If name on record is �Reront than that of applicant, indicate below: — `
�e of mortgagee a eorltract seller �
�3. ,
Address of rtrortpagee or contrad seller (number and street, city, state, ZIP
Name of ateignea or otl�er owner or holder of mortgage
Address of asaignee (number and stieet, city, stafe, ZIP crode)
Dces appAcarq awn property in arry other If yea, what county7
county in Indiana9
Deduction approved in the amount ot:
20 �1Q 20 0 � 20
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Signature
C 61.1-
Drawer N�........
......... —
, 3'11� -
Card NO. .. ��� .......
Taxing Distrid? Has this dedudion been requested on
property for curtent year? � Yes � No
COUNTY AUDITOR
20
County Aud'Aor
�
20
20
We certify.under tffe penalty af perjury that the above and foregoing information is true and coRect and that the applicants was / were
�esident of Indiana and owner of lhe aforementioned property on March 1, 20
executed
or by IC 6-1.1-12-.07
:siaent addresY�applipnt — ��' ^ IAddress of authorized person
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