HomeMy WebLinkAboutMortgage_Krieg (2)� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
S� State Fortn 43709 (RS / 4-03)
� PresaiEed by Department of Local Govemment Finance
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INSTRUCTIONS: IY[lY a�` Z003
To be filed in person or by mail with the County Auditor ol [he county whe�e the property is located.
Filing Dates: 1) Real Property: During the 12 months before May 11 oI the year tAe deduction is to be effecflve. �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0l the year f deduction '�� � ef(ective.
See reverse side (or additional instructions and qualifications. GIBSON COUfTV ,;�pITOR
Applicant
or contract
Taxing District // //1
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Assessed value of real property as of
March 1, curtent year
If no, what is his / her exacl share of interest?
on reve,�se side)
.
Key number / legat description cord number O�
/y�� OQ��� —VV Page number a��6
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MoAgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year /� �(f(f� owner? ❑ Yes ❑ No
If name on record is different than that of applicant, indicate below:
of mortgagee or contract seller
If owned with someone other than spouse, indicate with whom.
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Address of mortgagee or contract seller (number and st e, city, state, ZIP
Name of assignee or other owner or holder of mortgage
and street, city, state, ZIP code)
Does applicant own property
county in Indiana?
Deductlon approved in the amount of:
20
Signature
If yes, what county?
What
COUNTY AUDITOR
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Counry Auditor
❑ Real
� Mobae
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�wer N _
NO. .....................
� 20 � 20 � 20
P r� �
Date
E1.1
auested on
� Yes� No
certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March t, 20
Person authorized by duly executed Power of Attomey
or by IC G1.1-12-.07
of authorized person
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