HomeMy WebLinkAboutMortgage_Jines (4)���° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
.-- -: FOR DEDUCTION FROM ASSESSED VALUATION
'> � State Porm 43709 (R / 12-99)
� ui.
_� Prescnbed by State Board of Taz Commissioners
fee 51.00
FEB 28 �Ma�k
Instructions for filing:
To be filed in person or by mail with the County Auditor of ihe county where the property is
located during the 12 months before May 11 of the year the deduction is to be effective. See
reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Applicant (ow�or contract buyer= se� sMc ns on reverse side)
%�! A � l.�.J Q_,Ll/I.ISL,
Taxing Distrid
1 U11�11 I�C7�
Assessed value of real
March 1, current year
Key number / legal
' �O��L
of Mortgage / Contract iP
March 1, current year
If no, what is his / her exact share of interest?
If name on record is different lhan that of applicanf,
of moRgagee or contrad
Address of moRgagee or contrad seller (number and
below:
m Record numb
^� Page number
jness unpaid as of Is the ap,
, owner?
FORM 5
Year
t the sole legal or equitable
❑ Yes ❑ No
if owned with someone other lhan spouse, indicate with whom.
city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6erand street, city, state, ZIP code)
Does applicant own real property in any If yes, what county? What Taxing Distrid? Has fhis dedudion been requested on
other county in Indiana? property for current yeaR ❑ Yes � No
PROPERTY TAX ASSESSMENT BOARD OF APPEALS
Dedudion approved in the amount
20 �
t � /. -11.
20 n� ��� 20 f��B��V 20 �.2 20 Q�
, ,p. o'L � b,oi, I ��
Seaetary of PTABOA
20
Date
I'�
200 �
�
/ We crertiTy under Ihe penalty of perjury that the above and foregoing infortnation is true and correct and lhat the applicants was / were
� resident of Indiana and owner of the aforementioned property on March 1, 20
gnature (ow s full name) Person authorized by duly executed Power of Attomey
� � `_ �. or by IC 6-1.1-12-.07
authorized person