HomeMy WebLinkAboutMortgage_Denning��� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
's' = FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
� «� � Sfale Fortn 43709 (R6l 5-OG)
Presaibed by Oepartmenl of Lotal Govemment Finance
INSTRUCTIONS: File Mark
To be fi/ed in person or by mail with the County Auditor of the county where the property is located. �pN � 2 Z��7
Filing Dates: 1) Real Property: Dunng the 12 months befo2 ,lune 11 of the year the deduction is to be e'(fective.
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 0l the year the deduction is lo be eflective.
See reverse side (or additional instructions and quali�cations. ����j '��
� � GIBSON COUNTY AUDITOR
Applicant (owneror ract buyer- see re 'cfions on reverse side)
Taxing Distrid K number / le I escription. ' Record number
a�6 -1 ?~D 1- �'Cd -fby.6`�?-�2 �S
� p� r� O' rr n� �, Page number 0�(
t� J `r e'� J
Assessed vatue of real properiy as of Morlgage / Contrad indebtedness unpaia as uf Is the applicant the sole legal or equitable
March 1, cunent year March 1, cunent year ownef? ❑ Yes ❑ No
' � fO00D
If no, what is his / her exact share of interest? If owned wi er lhan spouse, indicate with whom.
If name on record is difierent lhan ihal of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Horne (IC 61.1-�
�me of mortgagee or contract seller
Address of moRgagee or contrad seller (number and street, , state, ZIP
� % (e
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sGeet, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Taxing District? Has lhis dedudion been requested on
county in Indiana? property for current year? � Yes ❑ No
COUNTY AUDITOR
Dedudion approved in the amount ot:
20 20 � 20 � 20 20 20 20
P
Signature County Auditor Date
�/ We certify under the penalty of peryury that the above and foregoing informalion is true and corred and that the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
i turef/owners name) Person authorized by duly executed Power of Attomey
/� or by IC 6-1.1-12-.07
l
Fuil sident address of applicant Address of authorized person