HomeMy WebLinkAboutMortgage_Pauley;a�'i° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�'� I � FOR DEDUCTION FROM ASSESSED VALUATION , P Year
Count Townshi
«. / SteU Form 43709 (RB / SO6) � � �
� Preaaihed Dy Depertment of Local Gwemment Finance
INSTRUCTlONS: S Ef�le $1gic2OO %
To be �led in person or by mail with the County Auditoi o( fhe county where the propeRy is localed.
Filing Dates: i) Real Pioperty: During the 12 months be%ie ,lune 11 of the year the deduction is to be eflective.`�'yJ
2) Mobrle Homes assessed under IC 6-7. 7-7: Between January 15 and March 2 of the year the deducL�s��ffective.
See reverse side !or additional instnictions and qualifications. G IBSON COUNTY AUDITOR
ApplicaM (owner or conbact
1 O.a. 1lss
Taxing Distrid
Pr„-�,,.� �.
see resMclions on reverse side)
Key number / legal descriplion
(p 80 - �a-1
��tis���� ��
number
number
Assessed yahre oi real property as of Mortgage / Cantrad indebtedness unpaid as of Is the applicant he sole legal or equitable
March 1, axrenl year March 1, current year owneR �s ❑ No
� ��
If no, what is his / her QxBCt shere of interest? I( owned with someone olher than spouse, indicate with whom.
name on record h diRerent than
Address ol
Name
a contred aeller
b-•.
eontract seller (number and stiset, city, state, ZIP
a ofher owner or holder of mortgage
aseipnee (number and street,
Does appBwM own propeAy in any other I If yes, what county7
county in Indfana4
approved in the amount ot:
❑ Mobile Home
Dra�ti�er i\'0...�.r% „
What Ta�cing " • •
Card 1�ip, . 33y
`� �9, 9oa '...
COUNTY AUDITOR
20 � I ZO Ay 20 I 20
1
County Auditor
�
20
Date
20
�-�
_ _
certity under ihe penalty of perjury lhal lhe above and foregoing information is true and coRed and lhat ihe applicants was / were
lent of Indians and owner of the aforementioned property on March 1, 20
Person authorized by duty executed Power of
or by IC 6-1.1-12-.07
W apD�ipnt U /1 IAddress of
i
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