HomeMy WebLinkAboutMortgage_LameySTATEMENT OF MORTGAGE OR CONTRACT INDI
FOR DEDUCTION FROM ASSESSED VALUATION
's / Sta;e Fwm 43709 (R514�3)
� PreSaiDetl by DepaM.ar,i o( Lo(al Gtivemment Finance
Coun Township Year
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INSTRUCTIONS: � � � ;(�� �
To be filed in person or by mail with the County Auditor of the county whe2 the property is located.
Filing Dates: 1) Real PropeRy: Dunng the 12 montAs befo2 May 11 o( the yea� the deduction is to be eBec�l ye.�`
2J Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the de� nN��o be effective.
See reverse side /or additional instiuctions and qual�cations. GIBSON COUNTY ,4UDi70R
contracf buyer-
Taxing
C� SQ.I�'^�
Assessed value of real property as of
March i, current year
what is his / her exact share of interest?
on
Key number / legal
Record number
O// — � �� _ � Page number
Mortgage / Contrad indebtedness unpaid as of Is the applicant'the sole legal or
March 1, current year owner? ❑ Yes 0 No
If name on record is differeni than Ihai ot applicant, indicate below:
�Te of mortgagee or contrad seller ��
Address of mortgagee or cont�ad seller (number and st2et, ity, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
with someone other lhan spouse, indicate with whom.
Is lhe property in question:
❑ Reai Property ❑ Mobile Home (IC Gt.1
Does applicant own property in any other If yes, what county? What Taxi--^`='-' '" � � sted on
county in Indiana? �s�..: p,Z �s❑ No
Drawer NO...... .•••�
/
COUNIY AUDITOR Card �t0 . .....................
Deduction approved in the amounl of:
20 (� �
�
20 �� I 20 �L 20 20
T P
County Auditor
20
20
certify under the penalty of perjury that the above and foregoing information is lrue and corred and lhat the applicants was / were
lent of Indiana and owner of the aforemenlioned property on March 1, 20
(owners full name)
a'''�a /j ��-�^a
:nt ddress of a plicant
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Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person