HomeMy WebLinkAboutMortgage_Garrett� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
's N� / Stata Fortn 43709 (R514-03J
r�.PmscnOed by Department of Loral Govemment Finance
INSTRUCTIONS:
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To be filed in person or by mail with the County Auditor of the county where the property is locate .�
Filing Dates: 1) Real Property: Durrng the 12 months before May 11 of fhe year the deduction is be effectiv :
2) Mobile Homes assessed underlC 6-1.1-7: Between January 15 and Ma�ch 2� y.eactb� ' ective.
See reverse side loradditional instructions and qualifrcations. GiBSON COUN7v AUDITOR
Applicanl (owner or cont�act buyer- see iestrictions on reverse s' e)
7
Taxing Distrid Ke number / legal description Record num� a- 5 i y
y�,7 � � �6,�6 �� Page number
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Assessed value of real property as of MoRgage / Contrad indebtedness unpaid as of Is the applicant ihesole legal or equitable
March 1, current year March 1, current year ownef? �l'es ❑ No
�a37 G07.
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the perty in quesiion:
�Properly ❑ Mobile Home QC E1.1-�
�ame of mortgagee or contrad seller �
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Address of moAgagee or contrect seller ( mber and st2et, city, state, ZIP_ - — � �
Name of assignee or other owner or holder of mortgage
Drawer NO. °.2.: ..�:f `�� L
Address of assignee (num6erand sfreef, city, state, ZIP code) Card NO . .....................
Does applicant own property in any other If yes, what wunry? V __sted on
county in Indiana? property for current year?C] Yes❑ No
I � � � COUNTY AUDITOR �Q
Deduction approved in the amount of:
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Signalure County Auditor Date
�/ We certify under lhe penalty of peryury thal the above and foregoing intormation is true and correcl and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
�iqpature (owners full name) � Person authorized by duly executed Power oT Attorney
Xor by IC 6-1.1-12-.07
FuII resident address of applicant Address of authorized person