HomeMy WebLinkAboutMortgage_FarmerSTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
�- ` FOR DEDUCTION FROM ASSESSED VALUATION
� SIatC Form 43709 (R4 / iP-07)
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� PrescribeC bi DepaNrenl 01 Lr::l C,ovemment Finance
INSTRUCTIONS:
To be (led in person or by mail with fhe County Audifor of the county whe2 the property is locatetl. -
Filing Dates: 1) Real PropeRy: During the 12 months betore May 11 0/ the year the deduction is to be eHgr,tjy,Q. J� Z��(�a
2) Mobile Homes assessed under IC 61.1-7: Between January 15 and March 31 0/ th/e year fhe deducfion'i3`Yo be eHective.
See reverse side lor additional instn�ctions and qualifica6ons. '/ , / Q n n
Applicant
Asses�ed value �real proF
March 1, curtent ear
�
If no, what is his / her exad
of
of
GIBSOtJ
Key number / legal description � Record number
C/uJ — oO i��O ' W ��3e number J O
Mortgage / Contract indebtedness unpaid as of Is the applipnt the sole legal or e
March 1 rrent year ownerT ❑ Yes ❑ No
�� � ��
/ If owned with someone other than spouse, indicate with whom.
If name on record is different than that of appticant, indicate below:
�ime of mortgagee or contrad seller ✓
/
Address of mortgagee or contrad seller (num er and street, city, state,
Name of assignee or other owner or holder of moAgage
Address of assignee (number and stieet, city, state, ZIP code)
Dces applicant own property in any other If yes, what county? What Taxing Distrid?
county in Indiana?
20
Signature
approved in the amount of:
20
COUNTY AUDITOR
20 9i � 20 �� 20 8�
� �
County Audilor
s the property in question:
❑ Real Property ❑ Mobile Hane (IC 6�1.
Has lhis deduction been requesletl on
property for curtent yeaR � Yes ❑ No
20
Date
20
' We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and ihat the applicants was / were
resident of Indiana and owner of the aforemenlioned property on March 1, 20
/�� I Person authorized by duly executed Power of Attomey
.�y�, ar by IC 6-1.1-12-.07
person
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