HomeMy WebLinkAboutMortgage_Cox (10)� i *'4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
`i•�; FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
`� -. w� -J State Fortn 43709 (R6 / SO6) � ' _ , _ • . • . � � �
Presoibed by Departmeni of Local Gavemment Finance �
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INSTRUCTIONS: � � � OCT � �1e���
To be filed in pe�son or by mail with the CountyAuditor o1 the county where the property is located.
Filing Dates: 1J Real Property: Dunng the 12 months belore ,1une 17 "of the year the deduction is to be efl���,�..} ,al.% •
2J Mobile Homes assessed unde� IC 6-1.1 J: Between January 15 and March 2 ot the year the ddducGon ' t �.effective.
See �everse side fo� additional instnictions and qual�cations.
GIBSON COUNTY A DQ7�:'.
Applicant (oivner or cont c b er- see tndio s on reve se s' )
Taxing Disirid Key number / �egal descri ' n Record number �/�
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� a� -%� -a 9-�cb—ooa.� u9 age number �O /
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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
Marcti t, cuaent year March 1, current year . owneR ❑ Yes ❑ No
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If no, what is his / her exad share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different ihan that of applicanl, indicate below: Is the property in question:
' • ❑ Real Properiy ❑ Mobile Hmie (IC 61.1-�
me of mortgagee or contract seller /_
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Address o( mortgagee orconUad seller (number and st , city, state, ZIP
Name of assignee or olher owner or holder of mortgage
Address of assignee (number and stieet, city, state, ZIP code)
Does applicant own property in any olher If yes, what county7 What Taxing District? Has this deducdon been requested on
county in Indiana? property for curtent yeaR � Yes ❑ No
COUNTY AUDITOR
Dedudion approved in the amounl of:
20 �_ 20 O9 20 20 20 20 20
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Signature County Auditor Date
We certify under the penalty of perjury that the above and foregoing information is true and correcl and lhat ihe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20 ,
Signature (owners full name) Person authorized by duly executed Power ot Atlomey
� or by IC 6-1.1-12-.07
Full resident address of appli nt Address of authorized person
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