HomeMy WebLinkAboutMortgage_Dukea�"� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'> = FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
«. ! Stete Fwm 43709 (R6 / 5-06)
� Presvibed by Depanmem of Laal Gavemment Fina�e
INSTRUCTIONS: � � � � ile ark
To be filed in person or by mail with the County Audito� of the county whe�e the p�operty i locat
Filing Dates: 1) Real Property: During the 12 months be(oie June Il of fhe yea� the dedu on �s to 6e effec6ve.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of ti�a�ths ��tlon is to be effective.
See reverse side for additional insVuctions and oualifications.
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Applicant (owner or cont b - see 2 trictions n rever e side)� G�gSON COUNTY AUDI
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Taxing District Key number / legal description Record number p�
v
/y� Page number
� � W aZ.S— �
Assessed value of real p perty as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sote legal or equitable
March 1, curtent year March 1, current year owner? Q 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 different than that of applicant, indicate below: Is the property in question:
���y O Mob� Home QC G1.1-�
�e of mortgagee or conVact seller ,
Address of moRgagee or contract seller (number and street, c' , state, ZIP
Name of assignee or other owner or holder of mortGaqe
Address of assignee (numberand street, city, sta DI'B�VG' �r� �oo..C....l.l f✓
Does applicant own property in any other If yes, � C�C� �rO. ... '_ ''� Has this deducGon been requested on
county in Indiana? t// r� ��5�� ��� property for wrrent year? ❑ Yes❑ No
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COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 � 20 20 20 20
�
Signature Counry Auditor Date
I/ We certiTy under the penalty of perjury ihat the above and foregaing infortnatio� is W e and conect and that the applicants was ! were
adent of Indiana and owner of the aforementioned property on March 1, 20 . �
� a natur owners full na e) Person authorized by duly executed Power of Attomey
Q or by IC 6-1.1-12-.07
L./
u resident address of applicant Address of authorized person