HomeMy WebLinkAboutMortgage_Lewis (10)��^4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
= FOR DEDUCTION FROM ASSESSED VALUATION C n Tow p ear
� w ! State Form 43709 (R6 / 5-06)
Presaibed by Depariment o} Lacal Gwemmenl Finance M R 1 2 2008
INSTRUCTIONS: O'<<Ffl8 Nt2�
To be filed in person or by mail with fhe CountyAuditor of the county where the propeRy is locafed. GIBSON C UNTY UDITOR
Filing Dates: 1) Real Property: Dunng the 12 months before June 17 of the year the deduction is to be e%clive.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year fhe deduction is to be effective.
See reverse srde for addrtional instructions and qual�cations.
buyer_-see
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Taxing Districj�
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Assessed value of real property as of
March 1, current year
no, what is his / her exact share of interesl?
If name on record is different than that
on ieverse side)
Key number / legal description Record number
�� -I 9 -/8-303 - DOD. �`�0 g
a� y p�� Pa9e numter � 3 3�
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, currenl year owneR ❑ Yes ❑ No
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If owned with someone other than spouse, indicate with whom.
indicate below:
�e of moRgagee or contract seller C/�
J
Address of mortgagee or contrad seller (number and street, city, state, ZII
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and sGeet, city, state, ZIP
Does applicant own property in any other I If yes, what county? Wha
county in Indiana?
Deduction approved in the amount of:
20 �� x 20 �J
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Signature
couNrr nuo
20 20
County Auditor
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20 � [u
Date
20
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No
We certify under the penalty of perjury lhat the above and foregoing infortnation is true and corred and that lhe applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
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Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
ull resltleM atltlress of applicant Address of authorized person
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