HomeMy WebLinkAboutMortgage_Nixon��� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
� E FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
b J Stata Fortn a3709 (R5 / 4-03)
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PresrnDed by Departmeni of Local Govemment Finance
INSTRUCTIONS: File Mark
To be 7iled in person or by mail with the County Auditor o/ the cowty where the property is located. A�'R L 5 20�5
Filing Dates: 1) Real Property: During the 72 months 6e%re May 11 0/ the year the deduction is to 6e eXective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the ye�r_�heQ�ed�i�s to be effective.
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See reverse side for additional instructions and quali�cations. ��
GIBSON COUNTY AUDITOR
Applicant
axing Distrid
' '/ ` ''
Assessed value oireal property as of
March 1, current year
If no, what is his / her exact share of interest?
on reverse
description
0� �— d 7o��/s—��
Record
number
u
Mortgage / Contract indebtedness unpaid as of Is the applicant the so�e legal or equitable
March 1, c ent year owner? ❑ Yes ❑ No
a�oo0
If owned with someone ofher than spouse, indicate with whom.
I( name on record is different Ihan thaf of applicant, indicate below:
,ame of mortgagee or contract seller ��
Address of mortgagee or contrad seller (number d streef, cify, state, ZIP
Name of assignee or other owner or holder of mortgage
of assignee (numberandstieet, city, state, ZIP
Does applicant own property in any other If yes, what county? I What Taxino n�=+^^'"
wunty in Indiana? n
J � r ��Y �`"
N-�x��' ,
Deduction approved in the amounf oL �� ��/�i %�" �
• �jU- �/�
zo � l� zo � zc � I zo � zo —
'Y
Signature
Couniy Audilor
s lhe property
❑ Real Procer
� Mobile Home (IC 6-1.
�Y- 9P
Has this deduction been requested on
property for current year?� Yes❑ No
�
Date
20
/ We certify under the penalty of perjury that the above and foregoing information is true and correct and fhat the applicants was / were
resident of Indiana and ovrner of the aforementioned property on March 1, 20
Fuil tes�er�Yad"�,fes�6t appljfant ` -�
�O /'-��� ,/�x s�1n Pl,.,�_�.�tll£ La
Person authorized by duly executed Pov+er o( Attorney
or by IC 6-1.1-12-.07
of authorized person