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Home My WebLink AboutMortgage_Tuley,,r.�•'r- v -,a �%5 �� M STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS FOR DEDUCTION FROM ASSESSED VALUATION Siale FOrm 43709 (R4 / 1 O-01) PrperiDetl Dy Department of Local Govemment Finance � � ' ' �' t 1: i � :�, � � i ;.] INSTRUCTIONS: File Mark To be filed in person or by mail with the County Auditor o/ the county where fhe property is located. N 0 � � 2 2Q02 Filing Dates: 1) Real Property: During the 12 months beloie May 11 0/ the year the deduction is to be ef/ective. 2) Mo6ile Homes assessed under IC &1.1-7: Between January 15 and March 31 of the ar the ded tio s to be ffe ive. See reverse side lor additlonal instructions and qualificafions. GIBSON COU�TY AUDITOR Applicant (owneror ntrac buyer- see re rictions on �e erse si e � Taxing Disirid Key numb legal descriplion Record number Q� �� 6,/( p„ _ Q/�Q 7 cy_� Page number /� -�� (J � °"E' �� ° ' `�5 Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable March 1, currenf year March 1, currenl ear owneR ❑ Yes ❑ No U� ✓ If no, what is his / her exact share of interest? f owned with someone other than spouse, indicate with whom. If name on record is different lhan that of applicant, indicale betow: Is the property in question: ❑ Real Property ❑ Mobile Home (IC 61.1-� �me of moAgagee or contract seller �� Address ot moRgagee or conVacl seller (number d street, city, state, ZIP Name of assignee or other owner or holder of mortgage Address of assignee (number and sbeet, aty, state, ZIP code) Does applipnt own property in any other If yes, what counry? What Tauing Distrid? Has this dedudion been requested on county in Indiana? property for curtent yeaf? � Yes ❑ No COUNTY AUDITOR Deduction approved in the amount of: 2o Q� Zo Q�_ xo � Zo p!Q_ zo zo �� zo 0� � � Signature County Auditor Dale �/ We certify under the penaHy of perjury that lhe above and foregoing infortnation is true and corred and lhat the applicants was / were a resident of Indiana and owner of the aforementioned property on March 1, 20 Signa re owners !ul name) Person authorized by duly executed Power of Attomey f�_ r� or by IC 6-1.1-12-.07 Full resident address of applipnt Pr ; n cQ�-o� Address of authorized person ��r�� a �o� 3 �� v��