HomeMy WebLinkAboutMortgage_HallettSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS �� �
FOR DEDUCTION FROM ASSESSED VALUATION Coun T ymship'j—� Yea
� 1 State Fortn 43709 (RS / 4-03)
PrescriDed Dy Departr.ent of I.ocal Govemment Finance NO V 0 g ZO
INSTRUCTIONS: �' �`���
To be filed in person or 6y mail with the County Auditor o( the counry where the property is located. G�BSON COUNTY q�DITOR
Filing Dates: 1) Real Property: During the 12 montbs before May 11 oI fhe year the deduction is to be eNective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to be effective.
See raverse side Ior additional instnictions and qualifrrations.
Applica t(owner or cro tract buyer - see 2stricfions on verse side)
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Taxing Distrid K y number / legal description Record number �DO �
I YI � �}�� _ D� �/ q_� Page number � Q �
lJ � 7
Assessed value 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 ownef? ❑ Yes ❑ No
,X�OdO
I( no, what is his / her exad share of interest? If owned wilh someone other lhan spouse, indicate with whom.
If name on record is different than that of appiicant, indicate below: Is the property in question:
❑ Real Prop�iy ❑ Mobile Home (IC 61.1-�
�me of mortgagee or conVaIX seller �/
Address of mortgagee or cont�ad seller (number and stieet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sfreet, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has lhis deduclion been requested on
counly in Indiana? property for current year? � Yes ❑ No
� _ UNTY AUDITOR
Dedudion approved in the amounl of:
20 n� 20 � 20 �_ 20 20 20 20
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Signature County Auditor Dale
� We certify under the penalty of perjury that the above and foregoing infortnation is true and correct and that ihe applicants was / were
a resident of Indiana and owner of the aforemenlioned property on March 1, 20
Signature wners full name) Person authorized by duty execuled Power of Attomey
or by IC 6-1.1-12-.07
ull resideqt ad ss of applicant Address of authorized person
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