HomeMy WebLinkAboutMortgage_Jaquemai£+�=T• y
ici � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'i>�; FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
w� < State Form 43709 (R6 f 5-06)
� Presaibed by Department of Loral Govemment Finance
INSTRUCTIONS: File MaAc
To be (iled in person or by mail with the CountyAuditor o!!he county whe�e the property is locafed. JUN 0 5 200%
Filing Dates: 1) Real Property: During the 12 months before June 17 of the year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0l the y�ahe d��n is to be eKective.
See reverse side for additional instnictions and quali(ications. GIBSON C0� TY AUDITOR
Applicant (owner
Taxing Distrid
Assessed value of real
March 1, wrrent year
buyer-see
as of
16 no, what is his / her exad share of
tions on reverse side)
Ke umber / legal description
, �a.!�t_��-�.
Mortgage / Contract indebtedness
March 1, wrcent year
Record number
��
`..., Page number ��y`
� �
as of is the applipnt the sole legal or
�oO owneR ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
If name on record is different lhan that of applicant, indicate below:
�ame of mortgagee or contract seller �
Address of mortgagee or conirect seller (number and stre t, city, state,
Name of assignee or
Address of
owner or holder of mortgage
(numberand street, ci
Does appiipnt own property in any other I�
county in Indiana?
Deduction appro� ed in the amount of:
20
Signalure
20 ��
t
UI':11�'CI- l�i��!�!!?',-�oo�
�
C.1P(1 �� . .....................
COUNTY AUDITOR
20 �g 20 20
P
County Auditor
❑ Real Pmperty O Mobile Home QC G1.1-�
Has this deduction been requested on
property for current yea(? � Yes ❑ No
20
�
We certify under the penalty of peryury that the above and foregoing information is true and corred and that the applicants was / were
'esident of Indiana and owner of the aforemenlioned property on March 1, 20
/ull name)
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
drps� of applican�/ U Address of authorized person
s �sa � P-�M.� �2���