HomeMy WebLinkAboutMortgage_Corne� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
• �w� J State Fortn 43709 (RS / 4-03) � ' -
� PresaiDed Oy Department of Local Govemmeni Finance �� ��
INSTRUCTIONS: � � `� �
File Mark
To be filed in person or by mail wiih the County Auditor ol the county where the property is located. ��N Q 1 2��6
Filing Dates: iJ Real P�operty. During the 12 montAs belore May 11 0l the year the deduction is to be e ective.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the ye'�ar thie deduction is to 6e eNective.
See reverse side for additional instructions and qualifications. �'`�a ���
GIBSON COUNTY HUDITOR
Taxing
side)
Key number / legal description � Record number
� � no S _D (��j �pQ 'Q � Page number
V
Assessed lue oi re roperty a of Mortgage / Contract indebledness unpaid as of Is the ap�
March 1, current year March 1, cu t year ownef?
��ISOD�
If no, what is his / her exact share of inleres�?
If name on rewrd is different than that of applicant, indicate below:
�me of mortgagee or contrad seller ✓
L J
Address of mortgagee or wntrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
`i'"7 ��
! the sole legal or equitable
❑ Yes ❑ No
with someone other than spouse, indicate with whom.
❑ Real Property ❑ Mobile Home QC &1.
Address of assignee (num6er and street, city, state, ZIP code)
Does applipnt own property in any other If yes, wha' _�-^ What Taxing District? Has this dedudion been requested on
county in Indiana? property for current yea(? � Yes ❑ No
Dra iver 1�,� � ��
DaducGon approved in the amount ot Ca�.d � \�/ ��
�, .
20 �_ 20 _O � 20 �` _ 20 �'''
County Auditor
�
Date
20
We certify under the penalty of perjury that ihe above and foregoing information is true and correct and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
resident address
��
Person authorized by duly executed Power of Attorney
or by IC 6-7.1-12-.07
authorized person