HomeMy WebLinkAboutMortgage_Eubanks (2)� RV�
; i' � A� STATEMENT OF MORTGAGE OR CONTRACT IN�EBTEDNESS
�i : FOR DEDUCTION FROM ASSESSED VALUATION Count � Township Year
�. �' State Fortn 43709 (R6 / S�O6) • . . . �
lu
� Prescribed by OeparVneni of Loni Govemmenl Finance
INSTRUCTIONS: AUG IF16 2007
To be !iled in pe�son or by mail with the County Auditor of the county whe�e the property is located. .
Frling Dates: 1) Real Property: Dunng the 12 months before June 11 of the year the deduction is to be eKective.
2) Mobile Homes assessed unde� IC 6-1. 7-7: Between January 15 and Ma�ch 2 of the year th�t�f� be effective.
See reverse side for additional instiuctions and qualifications. GIBSON COUNTY AUDITOR
contracf buyer- see
�� �
Distrid
Assessed value of real property as of
Maroh 1, current year
is his / her exad share of interest?
on reverse side)
Key numb,€r / legal description � Record number
d�-„-�3-ao a-�a.os6-o Pagenumber ����
Mortgage / Contract indebtedness unpaid as of . Is the applicant the sole legal or equitable
March 1, currenl year ownef? 0 Yes � No "
1 a5 �o�
If owned with someone other than spouse, indicate with whom.
If name on record is different ihan that of applicant, indicate below:
mortgagee or contrad seller
of mortgagee or wntrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and stieet, city, state, ZIP code)
Dces applicant own property in any
county in Indiana?
Is the property in question:
❑ Real Property ❑ Mobile Home QC 6-1.1-7J
�����,�. . ��'%-�1"•L�'
If yes, what county? What Taxing Distrid?
� COUNTY AUDITOR
Dedudidn approved in the amount of:
20 �,[' 20 0 20
P
Signature
�
20
County Auditor
20
Has this dedudion been requested on
property for current year? � Yes ❑ No
20
Date
20
We certify under the penalty of peryury that the above and foregoing informalion is true and correct and that lhe applicants was / were
�esident of Indiana and owner of the aforementioned property on March 1, 20
nature (owners full name) Person authorized by duly executed Power of Attorney
�.'1�� j�, �� �, � or by IC 6-1.1-12-.07
appiicant
of aulhorized person