HomeMy WebLinkAboutMortgage_Basham;'�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
.��� FOR DEDUCTION FROM ASSESSED VALUATION
+ Siate Form 43709 (R6 / 5-06)
� Presoi6ed by Depariment of Loml Gwemment Finance
INSTRUCTIONS:
Count Township Year
File Mark
To be filed in person or by mail with the County Auditor of the county where the property is locafed. �I I�I 2 9 20��
Frling Dates: 1) Real P�operty: During the 12 months before ,lune !7 of the year the deduction is to be ef/e RG�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year th�ed�bn��be effective.
See reverse side (or additional instructions and qualificalions. ��� ��
GIBSON COUNTY AUDITOR
Apptiwnt (owner or cont t yer see•resMctions on rever ide)
Taxing Dislrid Key number / legal description Record number /�
U
.� .� � , � Q ^ Page number � �
OC
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equilable
March 1, wrrent year March 1, current year owneR ❑ Yes � No
� ��
I( no, what is his / her exacl share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is difierent than that ot applicanf, indicate below: Is lhe property in queslion:
❑ Rea� Property ❑ Mobile Home (IC G1.1-�
me of mortgagee or contreQ seller
Address of mortgagee or contrad seller (number and sfreet, city, ate, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and stre� - - �
Does appiicant own property in any oth � DI'a\VCI' �'�.. � t........ � Has this dedudion been requested on
county in Indiana? � property for current yeaR � Yes � No
Card NO. �5°2p
......
, c�� .....�.�7, 9 33, tp
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Dedudion appro�•ed in the amount of:
20 0�_ 20 �_ 20 20 20 20 20
Signature County Auditor Date
� We certify under the penalty of perjury ihat the above and foregoing infortnation is true and correct and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
owners (ull name) Person auihorized by duly execuled Power of Atlomey
�� � or by IC 6-1.1-12-.07
ull resident address of applicant Address of authorized person
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