HomeMy WebLinkAboutMortgage_Hale (3)� �
� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�'�� �� �! State Fwm43709 (R5/4-03)
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. Prescnbed hy Department of Local Government Finance
lNSTRUCTIONS:
To�be filed in person or by mail with the CountyAuditor olthe county where the property is located. � 1 Z0�5
Filrng Dates: 1) Real Property: Dunng the 12 months before May 11 0/ the year the deduction is to be e�iv .
� 2) Mobile Homes assessed under IC 6-1.1 J: Between January 15 and March 2 of the yeai the deduction is to be eHective.
See reverse side for additional instructions and qualifications.
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GIBSON COUNTY AUDITOR
Applicant (owner or contra 6uy r- see �n ti s o reverse side)
Taxing Distrid Key number / legal description Record number ��
S,(� /� o ri1/�i Page number
'(J / 4 � (�(J
Assessed.vatue of real property as of Mortgage / ContraG indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owne(? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned wiih someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
- ❑ Real Property ❑ Mobile Home (IC 6�1.7-�
�3me of mortgagee or contract seller "
�
Address of mortgagee or contract seller (number and stree , city, state, ZIP �
Mame of assignee or other owner or hoider.of morigage -
Address of assignee (number andstreet, city, sfate, ZIP code)
Does applipnt ow� property in any other If yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? propeAy for current year? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 _Q� 20 b� 20 20 20 20
� � �
Signature County Auditor Date
r� 1 We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
Sig ture ers iul n Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
F r de r ss of appiicant R I/� ,^� _ Address of authorized person
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