HomeMy WebLinkAboutMortgage_PellSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
" FOR DEDUCTION FROM ASSESSED VALUATION
�+ ! State Fwm 43709 (RS / 6-03J - - . ,
PrescnDed Ey Department ot Loral Gtivemment Finance
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INSTRUCTIONS: �
Coun Township Year
File Mark
To ba filed in person or 6y mail with the County Auditor ol the county where the property is located. A PR 1 � 2006
Filing Dates: 1J Real Property: During the 12 months before May 11 0/ the year the deduction is to 6e eflective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year thetle,ductionas�6e effective.
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See reverse side lor additional instructions and quali(cations. �/
GIBSON COUNTY AUDITOR
Applicanl (owner or n cf buyer- see resMct� � reverse side) � �
111
Taxing Distrid Key number / legal d cription Record number /y��
�4� ODS-'Dl DyQ'c`X`X� civ
Page number
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitabte
March 1, curcent year March 1, currenl year owneR ❑ Yes ❑ No
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If no, what is his / her exact share of interest? Ii owned with someone other than spouse, indicate with whom.
If name on record is different Ihan that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobiie Home (IC 61.1-�
me of mortgagee or contraIX seller ��
Address of mortgagee or contract seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (nuniberand stieet, city, sfate, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this deduclion been requested on
county in Indiana? property for current year? � Yes � No
COUNTY AUDITOR
Deduction approved in lhe amount of:
20 �/ � 20 _Q� 20 _� 20 20 20 20
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Signature Counly Auditor Date
We certify under the penalty of peryury that the above and foregoing information is true and corred and fhat the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
gn re (owners full nar���� Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
fu re ' ent address f applicanl Address of authorized person
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