HomeMy WebLinkAboutMortgage_BusingSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
` / State Fortn 43709 (RS / 6-03) ' . � ,
� PiesaiDeC by Departmerrt of Local Govemment Finarxe
INSTRUCTIONS JAN Z �Is,M�rk
To be filed in person or by mail with the Counry Auditor o/ the county where the propeRy is located. LU �
Filing Dates: 1) Real Property: During the 12 months belore MayYl of the year the deduction is to be eBective. '
2) Mobile Homes assessed under IC 6-7.1-7: Between January 15 and Ma�ch 2 of the year��to 6e effective.
See reverse side for additional instructions and qualifications. QIBSON COUNTY AUDITOR
Applicant (owner co cf buyer ee resfrictions n revers& side)
Tacing Dis Key number / le escription Record number nOO
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,, / O// _ �//_� Page number
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Assessed vatue of real properiy as of MoRgage / Contrad indebted�ess unpaid as of Is the applicant the sole legal or equitable
March 1, curtentyear March 1, current year ' ���QQ�, owne(? ❑ Yes ❑ No
/a� �� ,
If no, whal is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is difterent than that of applicant, indicate below: Is the property in question:
❑ Real Property O Mobile Home pC 61.1-�
�e of mortgagee or contrad selier ��
Address of mortgagee or contract seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of moAgage
Address of assignee (num6erand sfreet, ciry, staG �
Drawer NO...°.�.�...:.:..
Does appliwnt own propeRy in any other If yes, N � � -is this dedudion been requested on
coun inlndiana? ' = 17oQ� � ert forcurrent ear?�Yes�No
b P v v
Card NO.�.....!..�...........
� (,a, 000. pO
'cnca���0'�f aax.d.4-�4.oy
Deduction approved in the amount of:
20 /_ 20 � 20 �� 20 '�1 20 20 20
� 1 � �.
Signature County Auditor Date
' We certify under the penalty of perjury lhat the above and foregoing information is true and correct and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signalure (owners full name) Person authorized by duly executed Power of Attorney
� � � or by IC 6-1.1-12-.07
F II resident ad ss ot applicant Address of authorized person
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