HomeMy WebLinkAboutMortgage_Gray� R�° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
o---: �: FOR DEDUCTION FROM ASSESSED VALUATION
'> > State Porm 43709 (R / 12-99)
��� .��1/1 prescnbed by Stale Boartl of Taz Commissioners
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InsVuctions for filing:
To be filed �in person or by mail with the County Auditor of the county where the property is
located during the 12 months before May 11 of the year the deduction is to be eHedive. See
reverse side for additional instructions and qualifications.
Applicant (owner or contract
Distrid
Assessed value of real
March 1, current year
If no, what is his / her exact
J '
as of
of interest?
on re,�erse side)
/V � `- -
Key number / legal
FORM 5
Filing fee $1.00
Coun Township Year
V ` /
���M��
MAY 0 9 Z��1
Record
GIBSON
oo� �/����Q!\ IPagenumberp�( � <�'�
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Mortgage / Contrad indebt ness unpaid as of Is the applicant the sole legal or e
March t, current year � ownef? ❑ Yes ❑ No
a�� � °' °�.
If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant,
of mortgagee or contract
below:
Address of mortgagee or contracl seller (number and streef, city, state, ZIP
Name
Address
or other owner or holder of mortgage
and st2et, city, sfate, ZIP code)
f
Does applicant own real propeRy in any If yes, what county? What Taxing Districl? Has this deduction been requested on
other county in Indiana? property for current year? ❑ YesO No
PROPERTY TAX ASSESSMENT BOARD OF APPEALS
Deduction
20
Signature
roved in the amount of:
20 20 �
d� (e'�.�h"b�- �i�
Secretary of PTABOA
20
20
r� /
/ We certify under the penalty of perjury lhat the above and foregoing information is true and correct and that the applicants was / were
resident of Indiana and owner of lhe aTorementioned property on March 1, 20
gn,a..�tur(e�(owne�ros fu/ll�n,ame) Person authorized by duly executed Power of Attomey
\]�.�G....� C.�,rii\n... A_. or by IC 6-1.1-12-.07
resident address of appli a�t Address of authorized person
R.Q.3 BaYz33 PR;N�,�fau.� 't96?0