HomeMy WebLinkAboutMortgage_Lashbrookrt�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'+'�`-' .= FOR DEDUCTION FROM ASSESSED VALUATION
S�J Siate Form 43709 (R4 / 10-01)
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� Presaibe0 by Deparimenl of Local Govemment Finance
INSTRUCTIONS:
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To 6e �led in person or by mail with the County Auditor o/ the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months be%re May 11 of the year the deduction is to be ef7ect' .
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 of the year t uct ' to / ef/ect e.
See reverse side loradditional instiuctions and quali�cations. GIBSON COUN7v qUDITOR
Applicant (owner or contract 6uye� - see restric 'ons on reverse side)
Taxing Distrid Key umb / legal description Record number
Q`I ' O� S� ^� Pagenumber � I
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Assessed value of real property as of MoAgage / Contracl indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, cunent year March 1, current year owne(? ❑ Yes ❑ No
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Ii no, what is his / her exact share of interesl? If owned wilh someone other than spouse, indicate with whom.
If name on record is different lhan that of applicant, indicate below: Is the property in question:
❑ Real Property O Mobile Home QC 61.1-�
M�e of mortgagee or wnlraIX seller
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Addre s of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and st�eef, city, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for current yea(?� Yes❑ No
COUNTY AUDITOR
Deduction approved in fhe amount of:
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Sig tured�l County Auditor Date
�'`Ne certify under the penalty of perjury that the above and Toregoing information is true and corred and that the applicants was / were
ident oi Indiana and owner of the atorementioned property on March 1, 20
Signature (owners full name) Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
Fu r ident address of applicant Address of authorized person
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