HomeMy WebLinkAboutMortgage_Scalesrty
1°��
� ,«. �
STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fartn 43709 (R6l S-06)
Prescribed by �epartmenl of Lopl Gwemment Finance
INSTRUCTIONS: � �
To be filed in person or by mail with the County Auditor ot the county whe�e fhe propeRy is located.
Filing Dates: 1) Real Property: During the 12 months befoie June I1 0/ the year the deducli�s ��'e �,a'tive.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduction is to be effective.
See �everse side lor additional instiuctions and quali/ications. �7/QO ,� �
GIBSON COUNTY AUDIT(
Applicant (ownei or con c er- see 2sM 'on reve e si )
Taxing istrid Key number / le a� description Record number
-� n� .A a� - i8- aY-a4�t -OOO. i� -oa�
///� /A /P/{ � // � �� '1 � ,�� Page number
� � �� �� ` �i
Assessed value of real property as of
March 1, current year
If no, what is his / her exact share of interest?
March 1, cu nt ear
� �O D O
If name on record is dif(erent ihan that of applicant, indicate below:
�me of mortgagee or contrad seller
����
Address of mortgagee or contrad seller (number and st2et, city, s.
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and stieet, city, state, ZIP code)
Ooes applicant own property in any other I If yes, what county?
county in Indiana?
a
2� �
Signature
Dra�ver i\'O..a20Q.'1::...4 �
Card i\�0.�? �
•�•�%S�; �0
�� a�
I � � ��
County Aud'Aor
,'�J
6
as of Is the applicant the sole legal or
owner? ❑ Yes ❑ No
��,�9�
If owned with someone other lhan spouse, indicate with wnom.
What Taxing Distrid?
fY AUDITOR
2�
❑ Real Property ❑ Mobile Home pC 61.
Has this deduction been requesled on
property for wrrent year? � Yes ❑ No
20
Date
.+��
We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
�nature (owners (ull name) Person authorized by duly executed Power of Attomey
� '� _ . 0 �i_ , � s_ . or by IC 6-1.1-12-.07
rull resident add(�ss ot applipnt
'�/o `� I,... Qak ��. r rs 8,,h.c� �w
' Y7�
ofauthorized person