HomeMy WebLinkAboutMortgage_Kirchoff�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i = FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
_ y State Form 43709 (R6 / 5-06)
/� Presaibed by Depanmenl of Local Gwemment Finarice �
iNSrRUCrioNS: APR 1 S�@a7a�*
To be Tled in person oi by mail with the County Audito� of the county where the properfy is located.
Filing Dates: i) Real Property: During the 12 months before June Il of the year the deduction is to b tive. �!�
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 oI the y r��cCbr�� is to be e/fective.
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See reverse side fo�additional instructions and qualifications. GIBSON COUNTY AUDITOR
see ieypcAOns on �eve�se
1 �
Key ber / legal�descnpuon � cord numG
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Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, cunent year owner? Q Yes � No
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If no, what is his / her exact share oi interest? IT owned with someone other than spouse, indicate with whom.
I( name on
mortgagee or contract
Address of mortgagee or contract seller (r
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and stieet, city, state. ZIP
�rtgage
3te, ZIP code) �
whatcounN?
What Taxing District?
.......... ................ I
COUNTY AUDITOR
Deduction approved in the amount of:
20 �� 20 � 20 � 20 20
P P �
Signature County Auditor
❑ Rea! PropeAy ❑ Mobile Home QC 61.1-7)
Has this deduc6on been requested on
properry for cument year? ❑ YesO No
20
20
We certify under the penalty of perjury that the above and foregoing infortnation is We and correct and that the applicants v✓as / were
�•sident oi Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power ot Attomey
or by IC 6-1.1-12-.07
�F�jl1 resident address of appliCaNt ' Address of authorized person
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