HomeMy WebLinkAboutMortgage_Johnsoni� STATEMENT OF MORTGAGE OR CONTRACT INbEBTEDNESS
i' FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
J S1ate Form 43709 (R6l 5-06) ����
� Resaibed by Department of Loral Gwemment Finance
INSTRUCTIONS: � � T F�Ie �v1��Q�]
To be (rled in person or by mail with the County Audito� of the county where the property is located.
Filing Dates: 1) Real Property: Dudng the 12 months before �une 11 of the year the deduction is to be effech�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 olthe yea� the 6educ�n��'e eflective.
See reverse side lor additional instructions and quali(icatrons_ GIBSON COUNTY AUDITOR
Taxing
-�
�
Assessed value ofreal
March 1, wrrent year
see
�v .
25 Oi
no, what is his / her exad share of interest?
L�"/ "' verse side)
�Ke number�l description
G-/4-G� =�U�-aoa.
�fll(p —c�brc
MoRgage / Contrad indebtedness unpaid as
March 1, cunent year
Record number
number
Is the applicant the sole legal or equitable
ownefl ' ❑ Yes ❑ No '
/ ��, � I
If owned with someone other than spouse, indicate with whom.
If name on record is diiferent than that of applicant, indicate below:
�me of mortgagee or conVaC seller
7 / � /
Address o1 mortgagee or contrad selier (number and stre t, city, state, ZIP
Name oi asaignee or other owner or holder of mortgage
Address ot assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
wunty in Irtdiana?
Deduction approved in the amount of:
20� 20 0 20
T `P
Signature
❑ Mobile Hm�e (IC 61.7-�
-- �........
Dra���er NO..Q�...
What Tax� I ��o�- , �
Card \O . ..................�
PHc. � � 13�� oo°. �
COUNTY AUDITOR
20
County Auditor
20
20
20
•d on
� No
certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that ihe applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
(avners /ul! name)
�
Person authorized by duly executed Power of Atlomey
or by IC 6-1.1-12-.07
of authorized person