HomeMy WebLinkAboutMortgage_Wright (5)j�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
`i :� FOR DEDUCTION FROM ASSESSED VALUATION
J State Form 43709 (R6l 5-061
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� Rescribed by Oepartmenl of Local Govemment Finance
INSTRUCTIONS:
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Count Township Year
FI E
JUN 1F;k �8d
To be filed in person o� by mail wrth the County Audito� of the county where the p�opeRy is located.
Filing Dates: 1) Real Property: Du�ng the 12 months before June �l of fhe year the deduc6on is to be etiective. /r
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 2 0l the year tYie �9c6'on�i `�lo be eflective.
See reverse side fo� additional instrucfions and qualfications. GIBSON COUNTY AUDIiO�
Applicant wne�or ntract buyer- see resMcfi s on reverse side � ^�
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Taxing islrict Key number / legal descriptio Record number ��
/�, GQ � Page number
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Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March t, curtent year March 1, current year '� r� owneR � Yes ❑ No
3�d
If no, what is his / her exad share of interest? If owned with omeone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in questlon - -
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me of mortgagee or conVact selier — f' ,
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Address of mortgagee or contract seller (n mber and street, city, state, ZIP -;aa ��A�2� �
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Name of assignee or other owner or holder of mortgage ,y
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Address of assignee (number and st2et, city, s[ate, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has lhis dedudion been requested on
county in Indiana? property for wrrent yeaR Q Yes � No
COUNTY AUDITOR
Deduction approved in the amounl of:
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Signature County Auditor Date
1 We ceAify under the penalty of perjury lhat the above and foregoing intormation is true and correct and lhat ihe applicanls was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners full name) . Person authorized by duly executed Power of Attomey
� / or by IC 6-1.1-72-.07
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Full resident address of applicant � Address of authorized person
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