HomeMy WebLinkAboutMortgage_Straightry" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
- ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S � Slate Fofm 43709 (R4 / 10-01) O
�u O�PrescribeC by Department of Local Govemmeni Finance
INSTRUCTIONS: ���� �y�
To be filed in person or by mail with the County Auditor of the county whe�e the propeRy a d.
Filing Dates: 1) Real Property: Dunng the 12 months before May 11 of the year the dedu on i e
2) Mo6ile Homes assessed under IC 6-1.1-7: Befween January 15 and March 31 of the year fhe deduction is to be eHective.
See �everse side foraddifional instniclions and qualifica6ons. ��� 1 7 Z0�2
Applican wnerorcontracf b�yer- se rictions on rever e side)
GIBSON COU� TY AUDITOR
Tauing Distrid Ke n mber / legal description Rewrd number��
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year ownef? ❑ Yes ❑ No
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If no, what is his / her exact share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: is the property in question:
❑ Real PropeAy ❑ Mobile Home QC 61.1-�
�me of mortgagee or contract seller
Address of mortgagee or contrad seller (number and st2et, ci(y, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distric[? Has this dedudion been requested on
county in Indiana? property for current yeaf?� YesO No
COUNTY AUDITOR
Dedudion approved in lhe amount of:
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Signalure County Auditor Date
We certiy under the penalty of perjury that the above and foregoing information is true and corred and thal ihe applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
Sig re (owne/s full nam Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Full resident address of applicant Address of authorized person
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