HomeMy WebLinkAboutMortgage_Clem (3). �>
�«.
�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (R514-03)
PreSaiDed by Department oF Loral Govemment Finance
� �/��.
c---,
1 �
INSTRUCTIONS: ,JAN �� ��
To be filed in person or by mail wRh the County Auditor of the county whe2 the propeRy is located.
Filing Dates: 1) Real Property: During the 12 months before May 11 of the year the deduction is to be efl�,9� �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year tffe de�lion�o be effective.
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Applicant (owner or,
Taxing Distric[
AsseSsed value�f real
March 1, current year
buyer-see
of
no, what is his / her exact share of interest?
reverse side)
Key number / legal
� �—C�//O�- �D
Record number �
Page number ^ ,
MoRgage / Contract indebt ness unpaid as of Is the applicant the soie legal or equitable
March 1, current year ���fQ owner? ❑ Yes ❑ No
C/
w � .
owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
�me of mortgagee or conired seller � %f
Address of mortgagee or contrad seller (number and st e�ci�ate, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does appiicant own property in any other If yes, what county? What T.
county in Indiana?
Deduction approved in the amount of:
20 �
�
Signature _
20
�❑ Real Property ❑ Mobile Hane QC E1.1-�
'�J -- - _
Drawer NO.O. T•"• ���y
� .- �
Card NO : .....................
. ___„��� oeen requested on
I property for current year? � Yes 0 No
COUNTY AUDITOR
20 � 20 �� 20
�
County Auditor
20
Date
20
We certify under the penalty of perjury that the above and foregoing information is true and corred and thal the applicants was / were
esident of Indiana and owner of the aforemenlioned property on March 1, 20
full name)
Person authorized by duly exewted Power of Attomey
or by IC 6-1.1-12-.07
0 XaP�''� l}/� ,�� _ IAddress of authorized person