HomeMy WebLinkAboutMortgage_KolhouseSTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
' � FOR DEDUCTION FROM ASSESSED VALUATION
1 � Slate Fwm 43709 (R4 / 10-01)
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� Presc�ibeG by DepaNrenl W Local Govemment Finance
INSTRUCTIONS:
Coun Township Year
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File Mark
To be filed in person or by mail with the County Auditor o/ the county where the property is located. AP k 2 3 2�03
Filing Dates: 1) Real Properfy: During the 12 months before May 11 0/ the year the deduction is to be.e/fective.
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 0/ the year the deductio1ri is to b�e effective.
See reverse side for additional instructions and qualifications. /�J'��'`'"��
GIBSON COI;N' �' ;�UDITO°
Applicant (owner or contract buyer- see restricGons on reverse side)
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Taxing DisUid Key mber / legal description Record number 0 3
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, currenl year ownef? �es ❑ No
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If no, what is his / her exact share of interest? If owned with sameone other than spouse, indicate with whom.
If name on recard is diiferent ihan that of applicant, indicate below: Is the property in question:
eal Property ❑ Mobile Home QC Cr1.1-�
"ame of mortgagee or contred seller
Addr s of mortgagee or conUact seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applipnt own property in any other If yes, what counry? What Taxing District? Has lhis dedudion been requested on
county in Indiana? property for curtent year?0 Yes� No
COUNTY AUDITOR
Deduction appraved in the amount of:
20 �_ 20 �� 20 0"s 20 [Z� 20 �� 20 � 20 �
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Signature County Audilor Date
I/ We certify under the penalty of peryury that the above and foregoing infortnation is true and corred and that the applicants was / were
resident of Indiana and owner of the aforemenlioned property on March 1, 20
Sigr�t re (owners ame) Person authorized by duly executed Power of Attomey
—� or by IC 6-1.1-12-.07
Full resident address of a licant Address of authorized person
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