HomeMy WebLinkAboutMortgage_Lemmons (2),•••an
/ei "� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
°i'�;= FOR DEDUCTION FROM ASSESSED VALUATION
� .�,='+ Stale Fortn 43709 (R6 / SO6) ' . . . . . .
Presaibed by Depariment of Lonl Govemment Finance
INSTRUCTIONS: � �
To be tiled in person or by mail with the County Auditor o/ the county whe�e the property is located.
Filing Dates: 7) Real Property: Dunng lhe 72 months be%re dune Il of the year the deduction is to be efl�iv�..� Z ZOO�
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduction is to be elfective.
See �everse side fo� additional instructions and qualifications. �j� ��
GIBSON COUNTY AUDITOR
Applicant (owner or confract buyer - see
����2�.� ,� v�
Taxing Dislrid '
���
Assessed value of real property as of
Marchl, curtent year
If no, what is his / her exad share of interest?
name on record is different than
of moAgagee or contrad
on reverse side)
. ,
_� _. -—o
Key number / legal description Record number
��-r8-aY-�Y -aoo. � �
G� � Page number v p,�
�O
MoAgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, current year owneR ❑ Yes ❑ No
8� D��� .
If owned with someone other than spouse, indicate with whom.
indicate below:
Address of moRgagee or contrad seller (numbe�'and st�eet, city, state, ZIP
Nartie of assignee or other owner or holder of mortgage
Address of assignee (numberand st�eet, city, state, ZIP code)
Does appliwnt own property in any other If yes, what counry? What
county in Indiana?
Deduction approved in the amounl of:
20 Q 20 20
1 �
Signature
COUNTY AUDITOR
20
County Auditor
20
Y\� . l,' . 07- sS� �
�Js lhe prop rty in question:
I❑ Real Roperty ❑ Mobile Horne QC 61.1-i
�. o�-UC.. i��—' `�3�
Dra�r•er \'O. � �.-.y1�.�3
CardNO . ............... ...
iested on
YesO No
20
20
We certify under lhe penalty of peryury that the above and foregoing infortnalion is true and correcl and thal Ihe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
residenl address of
DO
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
��6^ f� IAddress of authorized person