HomeMy WebLinkAboutMortgage_Edwards (2)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
t � Siate FOrm 43709 (R3 / 10-00) . �
� PresaibM Dy State Boartl ot Tau Comrtussioners
InsWctions for fiiing:
To be filed in person or by mail with the County Auditor of the county where the property is
IMn}� ��irinn 1hn 19 mnMhc hcfnrc Mav � � nf fhn vn�r thc dorlurfinn ic fn M aHnt3'va Raa
fORM 5
Coun Township Year
� � g1 �I���/
JUN 2 6 2001
� __' __ ______-_ _ _.__' _.._• . . _. ___ , __. _._ _ _ _ _ __ _ _ __ _ _ . _ _. _. _ _ _
reverse side far additional insWdions and qualfiptions.
- � GIBSON CGIL�T`I A(IDIT R
Appli owner con t yer- see 2s ' tions on 2verse side) _ . .
Taxing Distrid Key number / legal desuiption Record number (,\ /
(.J
� � I' ^ f�o L\I /� Page number �Q�
( �� U � �
Assessed value of real property as of Mortgage / Contrad indebtedne of Is the applipnt the sole legal or equitable
March 1, wrrent year March 1, current year �/ ./� v owner? ❑ Yes ❑ No
-.cd"Tv�vt/ �`'' -
If no, what is his / her exad share of interesi? If owned with someone other than spouse, indicate with whom.
Ii name on record is different than that of applicanl, indicate below:
�� of mortgagee or contrad seller
Address of mortgagee or conVad seller (number and stie , city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, aty, state, ZIP code)
Does applipnt own real property in any If yes, what county? What Taxing DisVid? Has this deduction been requested on
other county in Indiana? property for current yeaR� Yes❑ No
COUNTY AUDITOR
Dedudion approved in the amount of:
2o Q� zo zo o zo � zo � Zo 0 7 Zo �$_
5 ��o� � � �' P �
Signature �i County Auditor Date '
�' •
I� We certify under the penalty of perjury thal Ihe above and foregoing information is We and corred and ttiat the applicants was / were
ident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners full name) Person authorized by duly executed Power of Attomey
,✓�/�- l_ or by IC 61.1-12-.07
/��'�l Z
ull resident address of applipnt Address of author¢ed person
� 3Ub S- C� �� I.� S�- r-l. Brn,�l., h/ y G