HomeMy WebLinkAboutMortgage_Goodson��n STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
' � FOR DEDUCTION FROM ASSESSED VALUATION
�. _ ! State Fwrt: a3709 (RS / 4-03)
�� � P2scdDed Cy Department ol Local Gdvemment Finance
INSTRUCTIONS:
Coun Township Year
MAY 1 SF��`i`
To 6e filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: Dunng the 72 months belore May 11 0l the year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the yea��d�s to be eNective.
See reverse side fo� addilional instructions and qualifications. GIBSON COUNTY AUDITOR
Applicant wne� or con ract 6uy - see re cfions o verse si
Taxing Oistrid Key number / Iegal desaiption Record number
� O � ^ D ^� (� � � ' � I Page number �
�b 1
Assessed value of reai property as of Morigage / Contract indebtedness unpaid as of Is lhe applicant the soie legal or equitable
March 1, wrrent year March 1, current year owner? ❑ Yes ❑ No
tY u V V �
If no, what is his / her exact share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is ihe property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
�3me of mortgagee or contracl seller ,
Address of mortgagee or contrad seller (number and str t, ciry, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, stale, ZIP code)
Does appliwnt own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
county in Indiana? property for current year? � Yes❑ No
COUNTY AUDITOR
Deduction approved in the amounf of:
20 /� �/ 20 � 20 C� 20 20 20 20
�
Signature County Auditor Date
We ceAify under the penalry of perjury that the above and foregoing information is irue and correct and that the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners full name) Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
u resident address of applicant Address of authorized person