HomeMy WebLinkAboutMortgage_Larkinsi:�� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�j• State Form 43709 (R6 / SO6) '
� Prestri6ed by Departmem of Lo<al Govemrtrent Finance
INSTRUCTIONS:
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JAN 2 5F��'�
To be filed in person or by mail with the County Auditor o( the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months before June 11 0! lhe year the deductlon is fo be ve. "�!'
2) Mobile Homes assessed under IC 6-1.1-7: Belween January 15 and March 2 of the ye �ceer�,s to be eflective.
GIBSON U
See 2verse side for add8ional instructions and qual�cations. • COUNTy qUDITOR
Applicant (owner or contract b - see restricUons on ie rse s' e) �
Taxing Distrid Key number / legal description Record number Q/�
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Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, cunent year ownef? ❑ Yes ❑ No
If no, what is his / her exad share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is differeni ihan that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home pC 61.1-�
�e of moRgagee or contrad seller
Address of mortgagee or contrad seller (number and street, aty, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state "^--�-`
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Does applicant own property in any other If yes, wl I)1';1 \��C �� 1\` O.� v,� /. ;_�S �, :I as this dedudion been requesled on
counry in Indiana? ;.. �:roperty for curtent yeaR � Yes ❑ No
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Deduction approved in the amount of:
20 �_ 20 � 20 20 20 20 20
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Signature County Audilor Date
' We ceAify under the penalty of peryury that the above and foregoing infortnation is true and corred and that the applicants was / were
•si f of Indiana and owner of the aforementioned property on March 1, 20
tur ers (ull name) � Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
Fu ident address of appli t Address of authorized person
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