HomeMy WebLinkAboutMortgage_Lin�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
. � «. / State Form 43709 (R6 / 506) � � �
� Resvibed by Oeparimenf of Loral Gwemment Fina�a
wsrRUCnorvs: APR �a�r��
To be filed in person or by mail with the County Audito� of the counfy where the property is located.
Filing Dates: 1) Real Propeity: During the 12 months befoie ,lune �7 of the year the deduction is to 6e effec ' a�
2) Mobile Homes assessed unde� IC 6-i. f-7: Between January 15 and March 2 0( the year the dedGtti�is be effective.
GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant
District
contracf buye� - restrictions on �ev e side)
� � ���. � �"� �
Assessed value of real property as of
March 1, current year
If no, what is his / her exact share of interest?
Key number / legal description Record number
�� "�q-�9�"3�a-aDD 451- o0 %
Page number
�- -�ro a% l7'
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or e
March 1, wrrent year owner? � Yes � No
C.l� / (�
If owned with someone other than spouse, indicate with whom.
If name on record is dif(erent than that of applicant, indicate below:
�e of mortgagee or contract seller ^
Address of mortgagee or contract seller (�umble and stree , c , stafe, ZIP
assignee or other owner or holder of mortgage
�� • �' � 7-
Address oi assignee (number and straet, city, state, ZIP code)
Does applicant own property in any other Ii yes, what county?
wunty in Indiana?
approved in the amount of:
20 �i 2 I 20 �
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� Real Property ❑ Mob�1e Home QC G1.1-7)
��%-/S��%
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Taxing District?
COUNTY AUDITOR
20� 20 20
�
County Auditor
Has this deduction been reyuested on
property for current year? Q Yes❑ No
20
Date
20
I/ We certify under the penalty of perjury that the above and foregoing infortnation is true and cortect and that the applicants was / were
�sident oi Indiana and owner of the aforementioned property on March 1, 20
� a� ure �owneis �m� n- rn �
I
�Full r �dent address of applii
19G� �'_ S� n G1
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or by IC 6-1.1-12-.07
of authorized person