HomeMy WebLinkAboutMortgage_Baehl (4)l i^� : STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'nr :: FOR DEDUCTION FROM ASSESSED VALUATION
_ ! State Form 43709 (R6/5-06)
� Presaibed by Department of Loml Gavemment Finance
Count Township Year
�� �
JUN 0 6
INSTRUCTIONS: flt� Maric
To be filed in person o� 6y mail with fhe County Auditor of the county where the property is located.
Filing Dafes: iJ Real Property Dunng fhe 12 months before June 11 0l fhe year fhe deduction is to be�eijgFtivel3/�
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and Ma�ch 2 of the� year fhe/deductinn is to be eflective.
G�BSON COUNTY AUDITOR
See reverse side fo� additional instructions and qualifications.
or contracf buyer - see
,
Taxing Di§irid
�1'V."'"
Assessed value of real property as o(
March 1, curtent year
no, what is his / her exact share of interesl?
hons reverse si e) ���' �
a6 - -1 -
Key number / legal description Record number � �U ?
�/ J
�/ -IQ-��1�� �- DO� O6d'�d-S Pagenumber 9 C� S3
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or E
March t, currenl year owneR ❑ Yes ❑ No
�f0 pOv
If owned with someone other than spouse, indicate with whom.
If name on record is diHerent than that of applicanl,
13me of mortgagee or contract seller �/�
Address of mortgagee or conVacl seller (number and stieet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address o( assignee (numberand street, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
county in Indiana?
20 ��
4
Signature
appro� ed in the amount of:
20 c _
�
❑ Real
❑ Mobile Home (IC 61.
�)1':11VC1' ���..00.�.��'.!.!?f�
C8fC1 ��. .........��........
COUNTY AUDITOR
20 C�� 20 20
County Auditor
20
Date
been requested on
yeaR� Yes❑ No
20
We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
�esident of Indiana and owner of the aforemenlioned property on March 1, 20
natur (ow r-lu me) Person authorized by duly executed Power of Attomey
. . . � ,. ,,,, . � � � „� or by IC 6-1.1-12-.07
address of applicant �Address of authorized person