HomeMy WebLinkAboutMortgage_Wilson (2)� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
� i. State Form 43709 (RS / 4-03)
�«.
.� � P2scnDetl oy Department of Local Govemment Finance
Coun Township Year
INSTRUCTIONS: F�le
To be (led in person or 6y mai! with the County Auditor of the county where the propeRy is located. � U N �����5
Filing Dates: 1} Real Property: During the 12 months before May 11 0/ the year the deduction is to be eflective.
� - 2) Mobile Homes assessed under IC 6-t 1-7: Between January 75 and March 2 0/ the year the-�l� r�s'�be eflective.
O'�
See reverse side /o� additional instructions and qualifications.
� GIBSON COUNTY AUDITOR
ApplicaM(own�confrac buyer,see
Taxing Distrid � � �
� � I L.CI��v�.d v
Assessed value of real property as of
March 1, cuRent year
If no, �vhat is his / her exact share of interest? �
on
Key number / legal description � Record
^ 1 -00�
Mo g `/ Contrad inde
March 1, current year
� 5oc�
� age number
>s un�paid as of
Is the applicant the sole legal or
owner? ❑ Yes ❑ No
if owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
�me of mortgagee or contrect seller
Address o( mortgagee or contracl seller (number and st�eet, aty, stale, ZIP
Name of assignee�or other owner or holder of mortgage
Address of assignee (numberand street, city, state, ZIP code)
Does appiicant own property in any other I If yes, what counry?
county iri Indiana?
Deduction approved in lhe amounf of:
20
Signature
� •:
Is the property in question:
❑ Real Properiy ❑ Mo6ile Home (IC 61.
�' �
l`� 1
�vy;���:�` -
J �' ��� 1 _
.ei�� •��
Wnat l , ��`J� � :sted on
G�ia���J� > L� Yes � No
COUNTY AUDITOR
20 � 20 20
�
County Auditor
20
�
' We certify under the penalty of perjury that the above and foregoing information is W e and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duty executed Power of Atlorney
Q_ � or by IC 6-1.1-12-.07
of authorized person