HomeMy WebLinkAboutMortgage_Foleya� "� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i = FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
. w J State Fwm 43709 (R6 / 5-06) �
� Presaibed by Dapertmant of Local Govemment Finance
wsrRUCnoNS: APR 3 �����
To be filed in person or by mail with the County Auditor of the county where the propeRy is locafed.
Filing Dates: 1) Real Properry: During the 12 months before June 11 of the year the deduction is to be ctive.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Maich 2 of the yea�i�i�ded��is to be eflective.
See reverse side fo� additional instruc6ons and qual'Aications. GIBSON COUNTY B�fi�y
(owner ar
Taxing DisVict
- see
Assessed vatue of ra�l property as of
March 1, curtent year
If no, what
name on
/ her exact share of interest?
on
Key numtL�r I legal description
la-1` �aoo-cbo.s93 oa�
Mortgage / ConVact indebtedness unpaid as
March 1, current year
BI�VDv �a i�0:
If owned with someone
that of applicant, indicate below:
r� e ot mortgagee or contract seller �^ � I�
. i_ L
Address ot mortgagee or conVact seller (number and street, city, state, ZIP
Name of assignee or other owner or
Address of assignee (num6er and si
Does applicant own property in any <
county in Indiana?
mortgage
� 5�,, �y �
��y
Deduction approved in the amount of:
20 �� 20 � Q 20 _Q Q
�O P
Signature
20
County Auditor
�o��_
��'���a'
20
ecord number � ^
.i
age number O �
Is the applicant the sole legal or equita
owner? Q Yes � No
�er than spouse, indicate with whom.
Is the property in question:
❑ Real Properly O Modle Home pC 61.
Has this deduction been requested on
property for current year? ❑ YesO No
T�]
20
I/ We ceRify under the penalty of perjury that the above and toregoing infortnation is We and correct and that the applicants was / were
�s�dent of Indiana and owner of the aforementioned propeRy on March t, 20
%nature ( s full mev),� l Person authorized by duly executed Power of Attomey
�! A A.. � 1! _\ � �.� or by IC 6-1.1-12-.07
person