HomeMy WebLinkAboutMortgage_Havill�" STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
�- � FOR DEDUCTION FROM ASSESSED VALUATION
_S � Slate Form 43709 (R4 / 10-07 )
P�escribed by DeDartmenl W Local Govemment Financz
INSTRUCTIONS:
To be filed in person or by mai! with the County Auditor ol fhe county whe2 the properiy is located.
Filing Dafes: 1) Real Property: Dunng the 12 months belore May 11 of the year the deduction is to be effealidHV 2 2003
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0/ the,year the deduction is to be e/%ctive.
See reverse side for additional rnstructions and qualifications.
or contract buyer- see restrictions on reverse side)
Ca � X �l O. _1i�. � Y�. .r�li e 1��
Taxing Distrid
Assessed vatue of real properiy as of
March 1, current year
If no, what is his / her exad share of interest?
GIBSON
q
Key numhC} / legal description Record number
� a..
^ O ^ �� Page number q �
1
MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, currenl year owneR ❑�e. ❑ No
r
If owned with someone other than spouse, indicate with whom.
name on record is different than that of applicant, indicate below:
of mortgagee or contrad selier
1 . c� . � (
or conVad selier (number and street, city, state, ZIP
or other owner or holder oi mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Does applicant own property in arry other If yes, what county? I What Taxing Distrid?
county in Indiana?
Deduction approved in the amount of:
'�Ix'��
COUNTY AUDITOR
20 C g 20() ir, 20
� �
Counly Auditor
❑ Mobile Home pC 61.
�
Has this dedudion been requested on
property for current yeaR � Yes ❑ No
20 �� 2o c
P
Date
' We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
61D IAddress of authorized person