HomeMy WebLinkAboutMortgage_Rhodes� � STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
: N� / State Fwm 43709 (RS / a-03) � . . . •
� PrescriDed 6y Department of Local Govemment Finance
iNSraucnoNS: FEB 0 9 20f1C� Ma�
To be filed in person or by mail with the CountyAudiror of the county where the property is located.
Filing Dates: 1) Real Property: Dunng the 12 months befo2 May 11 0l the year the deduction is to be effective�.y_
2J Mobile Homes assessed under IC 6-i.1-7: Between January 15 and March 2 o(the y�'�"r�� devucqon is fo 6e elfective.
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See 2verse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Applicant (ownerorcontrac�§uye�
/
/\
Taxing District
aas ay�od-�
Assessed value of real property as of
March 1, current year
on
Key number / legal description � Record number
Page number � �
Mortgage / Contract indebtedness unpaid as of Is the apptica t the sole legal or equitable
March 1, wrrent year owneR �Yes ❑ No .
T
If nq what is his / her ezact share of interesl? �--
If name on record is different lhan that of applicant, indicate below:
of mortgagee or contract seller
a� l
If owned with someone olher than spouse, indicate with whom.
mortgagee or contrad selier (number and street, city, state, ZIP
of assignee or other owner or holder of mortgage
Address of assignee (numberand street, city, state, ZIP code)
Dces applicant own property in any other If yes, what counry?
wunty in Indiana? .
Deduction approved in the amount of:
20
Signature
20 _p_8_
s �the/property in question:
O iF'eal Property ❑ Mobile Home pC 61.1
vl f-1
Dratcer i\'O..G.�..-;. � � —
CaP(� 1�'�. ,,, ''
What Taxiny .,._. � �'""' sted on
I �' �r- -. (es ❑ No
COUNTY AUDITOR
20 � 20 20
�
County Auditor
20
Date
20
We ceAi(y under the penalty of perjury that the above and foregoing information is lrue and corred and that the applicants was / were
�esident�of Indiana and owner of the aforementioned property on March 1, 20
i
Q-�v G�
address of applicant
-7�/ I�dX�7A
e/,�
Person authorized by duly executed Power of Attomey
or by IC 6-7.1-12-.07
of authorized person