HomeMy WebLinkAboutMortgage_Dowtyie�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�i'�; FOR DEDUCTION FROM ASSESSED VALUATION
... N� . T State Form 43709 (R6 / SO6)
� Presmbed by Oepariment of Lwzl Gwemment Finance
INSTRUCTIONS:
Count Township Year
File Mark
To be frled in person or by mail with the County Audito� ot the county where the p�operty is /ocafed. MAR !. % C0�!'�
Filing Dates: i) Real P�operty: Dunng fhe 12 months before June I i o/ the year the deduction is lo be el%ctive.
2) Mobile Homes assessed under IC 6-L 1 J: Between January 15 and March 2 0/ the year.tGe_ded��s to be eBective.
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See reverse side for additional instructions and qualifications. . GIBSON COUNTY AUDITOR
Applicant wner or cont ct buyer- se trictions on reverse side)
Taxing Distrid Key num legal description Record number
J Page number / �
- O�I- O - 'i - (�
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
MarcFi 1, wrrent year March 1, current year ownef? �1'es ❑ No
�JrOod
Ii no, what is his / her exact share of interest? If owned with someone olher lhan spouse, indicate wilh whom.
If name on record is different ihan that of applicant, indicate below: Is the property in question:
Real Prope�iy ❑ Mobile Home pC Crt.t-�
e of mortgagee or contrad seller
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Address of mortgagee or contract seller (number and s6eet, ci , state, ZIP .
--__` _ �cai.uN �
Name of assignee or other owner or holder of mortgage � p�., �{ . l� O��
9U d� l] �s IQ�.�
Address of assignee (num6er and street, city, state, ZIP code) 1.t7.�G�?� �� �
Does applicant own property in any other If yes, what counry? Whs ��(O�� _�uested on
county in Indiana? property for wrtent year? � Yes � No
COUNTY AUDITOR
Deduction approved in the amount of:
20 S$_ 20 20 20 20 20 20
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Signature County Auditor Date
�' We certify under the penalty of perjury that the above and foregoing information is true and corred and thal lhe applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
Signat ( ner full n me) Person authorized by duly executed Power of Attomey
`� or by IC 6-1.1-12-.07
Full si ent addre s of applicant Address of authorized person
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