HomeMy WebLinkAboutMortgage_Trible� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S / State Fwm 43709 (RS I 4-03)
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� P`escnbe0 Dy Departrtwnt of loca� Govemment Finance
INSTRUCTIONS: - File Mark
To be filed in person or 6y mail with the County Auditor ol the county where the property is located.
Filing Dates: 1J Real Property: Dunng the 12 months 6efore May 11 of tAe year the deduction is to be eflective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0l the year fh�e uc �o�o �e�
See reverse side lor additional instructions and qualiTcations.
g�
(owner
Taxing
see resfeictions
Assessed value of real property as of
March i, curtent year
�io, what is his / her exact share of interest?
number /
d number '
GIBSON
number
U � U v � `� oL � � �
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, ent year owneR ❑ Yes ❑ No
l � �06 �
If owned with someone olher lhan spouse, indicate with whom.
��-iR-rq� ao�r-�i. aa��oa
If name on record is different ihan thaf of applicant, indic
'me of mortgagee or contract seiler ,
�..��(��� u ��2.. `
Address of mortgagee or conlrad seller (number and sti
assignee or other owner or holder of mortgage
below:
i
ciry, s�
Address of assignee (number and sfreet, city. state, ZIP code)
Does applicant own property in any other If vas. what county?
county in Indiana?
Dedudion approved in the amount of:
20 �_ 20 � 20
P �
Signature
What Taxing Distrid?
COUNTY AUDITOR
20
County Auditor
20
❑ Real Pmperly ❑ Mobile Hmie (IC 61.
Has this dedudion been requested on
property for current yeaf? � Yes � No
20
Date
3�]
We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
esiden of I diana and owner of the afor ned property on March 1, 20
natu (ow ers f 11 rame Person authorized by duly executed Power of Attomey
,� n„ � ., �O' or by IC 6-1.1-12-.07
Ent aaoreB's ot appkEa�r t' � Address of authorized person
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