HomeMy WebLinkAboutMortgage_LaGrange\
rtN
STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�'. w� / State Fwm 43709 (RS / 4-03)
� PresriiDed by Department of local Gtivemment Finance
INSTRUCTIONS:
To be filed in person or by mail witA the CountyAuditor of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months before May 11 0/ the year the deduction is to 6e effective. �/� N � 3 2�05
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to be eHective.
See reverse side /or additional instructions and quali(cations.
�� ��
GIBSON COUNTY AUDITOR
Applicant (owner or tract buyer- see restnct ns verse side)
Taxing Distrid Key number / Iegai aiption Record number
� � � ,,n \ Page number
V C,
Assessed value of real property s of Mortgage / Contract indebtedness unpaid as of Is the applicant the`sole legal or equitable
March 1, curtent year March 1, currenl year owner? ❑ Yes ❑ No
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than lhat of appiicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home pC 61.1-�
��ne of mortgagee or contract seller
Address of mortgagee or contrad seller (number street, city, state, ZIP
Name of assignee or other owner or holder of mo age
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any olher If yes, what counry? VYhat Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for current year? Q Yes � No
COUNTY AUDITOR
Deduction approved in the amount oL
20 L7 (� 20 20 �7� 20 _Q� 20 20 20
1
Signature - County Auditor Date
�' We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
asident of Indiana and owner of lhe aforementioned property on March 1, 20
S' nature ers full narpe) Person authorized by duly executed Power of Attomey �
��� or by IC 6-1.1-12-.07
sident address of applicant Address of authorized person
( �
-----------------------------------------------