HomeMy WebLinkAboutMortgage_Collins�" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-° :� FOR DEDUCTION FROM ASSESSED VALUATION
S� - y S�ate Fofm 43709 (R4 / 16-07)
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� Prescribed by Depanment of Lo:al Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor o! the county whe�e the property is located.�1 �L� 2 2��3
Filing Dates: 1) Real PropeRy: Dunng the 12 months befoie May 11 0/ the year the deduction is to De�etiec�ve.
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 o{the year the deduction is to 6e effective.
See reverse side tor additional instruc6ons and quali(rcations. JJ�,
GIBSON COU�iI' AUC�iTOft
Applicant (owner or cont yer- see rest ' tions on reve e' e) ����� I��J '`v
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Taxing Distrid Key number / leg I descripC n Record number D�
Q� Do5 —v �{i Ga -o o Page number �,!�
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Assessed value real pro as of MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, ent year ownef? ❑ Yes ❑ No
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If no, what is his / her exad share of interest? I( owned with someone other than spouse, indicate with whom.
If name on record is diflerent ihan that of applicant, indicate below: Is the property in queslion:
❑ Real Pmperiy � Mobile Home QC 61.1-�
�"ame of mortgagee or contrad seller ��
Address of mortgagee or conVact seller (number and treet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and st2et, city, state, ZIP code)
Ooes applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
counly in Indiana? property for current yeaf? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amounl of:
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Signature County Auditor Date
�/ We certiTy under the penalty of perjury thal the above and foregoing informalion is true and corred and ihat the applicants was / were
•resident of Indiana and owner of the aforemenlioned property on March 1, 20
ignature (owners full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Full reside add ss of applipnt Address of authorized person
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