HomeMy WebLinkAboutMortgage_Myers (2)a�`�'��"�" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
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i•'�; FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
� �? • Stale Fortn 43709 (R6 / 5-06) . � • .
Presaibed by �epariment of Local Govemment Finance
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INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor of the county where lhe property is located. Q� � 1 � 200 �
Filing Dates: 1J Real Property: Du�ng the 72 months 6e%re ,lune 17 of fhe year the deduction is to be elfective.
2) Mobile Homes assessed under IC 6-1.7-7: Between January 15 and Ma�ch 2 of the year the�AeducGqq�o be etfective.
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See �everse side for additional instructions and qualifications. (/
GIBSON COUNTY AUDITOR
Applicant (owner or contract buyer- see
Ta�cing
Assassed value of real property as of
AAarch 1, current year
Itno, what is his / her exacl share of interest?
on reverse
Key number / legal description
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Mortgage / ContraU ir
March i, current year
on record is different than that of applicant, indicate below:
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u
�s unpaid as of
�rd number O 7
: number ��G
Is ihe applicant the si
owneR ' ' �e:
9
legal or equitable
❑ No
If owned with someone other than spouse, indicate with whom.
mortgagee or contracl seller
Q � EII i ) • • . J
of mortg�ee or contraa seller (number and street, city, stafe, ZIP
„
Name of assignee or other owner or holder of moAgage
(number and street, city, state, ZIP code)
Does applicant own property in any other if yes, what county? I What Taxing
county in Indiana?
Deduction approved in the amount of:
20 ��' 20 � 9 20
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Signature
COUNTY AUDITOR
3�7
County Auditar
20
Is the
❑ Mabile Home (IC 61.
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� prope r t y tor wrrem yem����-�.... J N o
20
Date
20
ceAify under lhe penalty of perjury lhat the above and foregoing information is true and corred and that lhe applirants was / were
lent of Indiana and owner of the aforementioned property on March 7, 20
(owners /yll name)
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
esdent address of appliqnt 0 Address of aufhorized person
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