HomeMy WebLinkAboutMortgage_Burg�.
e`O R�'�° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
;�_e, t
e+ = FOR DEDUCTION FROM ASSESSED VALUATION
S�y State Form 43709 (R4l 70-01)
a.
� Prescribe0 by Department ol Local Government Finance �
INSTRUCTIONS:
7o be filed in person or by mail with the County Auditor ol the county whe�e the property is loc�� O� �0��
Filing Dates: 1) Real PropeRy: During the 12 months before May 1 t o/ the year the deduction �s to e e ec v.
2) Mo6ile Homes assessed under IC 6-1.1-7: Behveen January 15 and Marc`r31 of the y�ar deduction ' to be eHective.
�/
See reverse side for addifional instnictions and quali�cations. t.�r��),�)
GIBSON COU" T Y AUOITOR
Applicant (owne� or c tract buyer- see restrictions o ver ide)
Taxing DistriG Key number / legal descri i n Record number
�^ � O Page number� �
�� �l/� W �
Assessed vatue oi real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 7, current year gQ � ownef? ❑ Yes ❑ No
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicanl, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home pC E1.1-�
�ie of moRgagee or conlrad seller
sl3
Address of mortgagee or contrad seiler (number and street, city, state, ZIP� ' "
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? property for current year?� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
zo ��, m zo zo zo � Zo � zo � zo ��
5 �,A p PTfi0o74' (� ,0 /
SignaWre [7�y County Auditor Date
�' e ify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
i nt of Indiana and owner of the aforementioned property on March 1, 20
S n e(own full name) Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
ull esident address of appliqnt . F Address of authorized person
a o'�e 4z 6s