HomeMy WebLinkAboutMortgage_RaneySTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
` / State Fwm 43709 (RS / 4-03)
� PresaiDed Dy Departmznt of Local Govemment Finance
INSTRUCTIONS:
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Nov 2 �;�aa,a�
To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: i) Real Property: Dunng the 12 months be7ore May 11 0/ the year fhe deduction is to be e%fecfiqe. ��
2J Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0l the year fhe`de"'duchon�s to 6e effective.
See 2verse side /or additional instnictions and qualifications. GIBSON COUNTY AUDITOR
Applicant (owneror ntract buyer- see restnctions on se side)
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Tauing Distrid Key number / legai descrip' Record number
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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, curcent year March 1, currenl year ownef? ❑ Yes � No
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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 different ihan that of applicant, indicate below: Is the property in question:
❑ Real Properiy ❑ Mobile Home pC 61.1-�
�me of mortgagee or contract seller ��
Address ot mortgagee or contrect seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and stieet, city, state, ZIP code)
Does appliqnt own property in any other If yes, what counry? What Taxing District? Has this dedudion been requested on
county in Indiana? property for current year?0 Yes� No
COUNTY AUDITOR
OeducGon approved in the amount of:
20 / 20� 20 L� 20 20 20 20
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Signature County Audilor Date
�� We certi under the penalry of perjury that the above and foregoing infortnation is true and corred and that lhe applicants was / were
� resi of Indiana and owner of the aforementioned property on March 1, 20
�' atur wners (ull name) Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
Fu sident ress o applicant Address of authorized person
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