HomeMy WebLinkAboutMortgage_Stevens (3)�
STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�� ��� �i Slete Fwm 43709 (RS / 4-03)
� Pm5tnE9d py Department of local Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Audiror of the county whe2 the property is locateo. —
Filing Dates: 1J Real Property: During the 12 months 6efore May 11 of the year the deduction is to be ef/ectiv�� f N ,nnC
� 2) Mobile Homes assessed under IC 6-1.1-7: Between January 75 and March 2 0/ the year the deduction 4 td�8�effective.
See reverse side for additional instructions and qualifications.
(owner or contracf
Ta�cing
I� l�'�� � �' ,
Assessed value of real property as of
March 1, curteni year
no, what is �his i her exact share of inlerest?
Key number / legal
�
March 1,
GIBSON
/ V
_/1� � ({��� Page number ��
z� �
/ ContraG indebtedness unpaid as of Is the applicant the sole legat or equitable
.urrent yea I 31, 5 75, � owne(? ❑ Yes ❑ No
I�$Soo
If name on record is different than that of applicant, indicate below:
o( mortgagee or contraIX seller
Address of mortgagee or contract seller (number and
Name of assignee�o� other owner or holder ot mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what counry?
counry in Indiana?
Deduction approved in the amount of:
20 DY�
/
Signature _
20
If owned with someone other than spouse, indicate with whom.
state,
What Taxing Districl?
COUNTY AUDITOR
zo 20 20
County Auditor
property in question:
❑ Mobile Horrie pC 61.
Has this deduclion been requested on
property for current year? � Yes � No
zo
Date
20
� We certify under the penalty of perjury that the above and foregoing information is true and correcl and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
r
Person authorized by duly executed I
or by IC 6-1.1-12-.07
4ddress of authorized person
�wer of Attomey