HomeMy WebLinkAboutMortgage_Crabtree (4)STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
' � FOR DEDUCTION FROM ASSESSED VALUATION
S � Siale FOrtn 43709 (R4 I 10-01)
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� Presaibea by Department of Loral Govemment Finance
INSTRUCTIONS:
To be filed in person or 6y mail with the County Auditor o/ the county where the property is located. Ar j� �� ZQQ3
Filing Dates: 1) Real Property: Dunng fhe 12 months befo2 May 11 0l the yea� the deduction is to be effective.
2) Mobile Homes assessed under IC 61.1-7: Between January 15 and March 31 0/ the yeaI/ the deducti is'to 6e ef(/•ec�tivf,/e.
See reverse side for additional instructions and qualifica6ons. /�/�J-��"`��-� -f
• GIBSON CfOUNTY" �uD1TOR I
Applicant (owne� or contracf buyer- see restrictlons on reverse side)
Taxing DisUid y er / descrip ion Record number
Page number
- �(00
Assesse alue of rea roperty as of MoAgage / Conirad inde tedness unpaid as of Is the appli nt the sole legal or equitable
March 1, current year March 1, current year owneR �es ❑ No
\
90�
Ii no, what is his / her exad share of interesl? If owned wilh sameone ather than spouse, indicate with whom.
If name on record is difierent than that of appticant, indicate below: Is the property in question:
eal Property ❑ Mobile Home (IC Fr1.1-�
ame of moAgagee or contract seller
� i1�. ` �C_.��`G�'s�
Address of mortgage r contrad seller (number and st2et, aty, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
counly in Indiana? property for wrrent year? � Yes ❑ No
COUNTY AUDITOR
DeducGon approved in the amount of:
20 �,� zo Zo zoa (� zo Q� zo �� zo �
P�F (3or� � Zo
Signature County AudRor Date
I/ We certify under the penalty of perjury thal the above and foregoing information is true and corred and that lhe applicants was ! were
• resident of Indiana and owner of the aforementioned property on March 1, 20
Signalure (owners lull name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Full r' ss o applipnt Address of authorized person
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