HomeMy WebLinkAboutMortgage_Riley (5)STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
��« J State Form 43709 (RS / 4�3)
PresaiDeE Cy Department of Local Govemment Finance - �
A R� 1L/
INSTRUCTIONS: File Mark
To be filed in person or 6y mail with the County Auditor ol the county where the property is located. ,J U � 3 1 ZQQ6
Filing Dates: 1J Real Property: During the 12 mon[As before May 11 of the year the deduction �i be e/%ctive.
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2�6f the year the deduction is to be effective.
See reverse side for additional instructions and qualifications. ���j 'G� 0'
GIBSON COUNTY AUDITOF.
Applicant (owner
-see
Taxing Dislrid � Key number / leg I description
/�-o -�dd-oo3.7oa-6�/
�,�7�, �nTrr nn i � ���- 03 �o a-o c�
Assessed value of
March i, current yi
Ii �io, what is his / her exacl share of interesP
7� y�,—
If name on record is D� "W �
� ra iv�r ��r0
of mortgagr Ca
Record
Page
, �
Mortgage / ContreC indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, curtent year ownef? ❑ Yes ❑ No
� /�OQ
If owned with someone other than spouse, indicate with whom.
`'���viicate below: Is the property in question:
, cai'�-„ \ � ❑ Real aropeny o Modle Home �c s,.,-�
�'�,(O
_. � ra,�,o. yo ..
Address of morty.., �t't-Q� p " �
�_Q �
7
Name of assignee or other owner or holder o� �
(number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what counry?
counry in Indiana?
Dedudion
20 ��1
P
Signature
the amounf of:
� � .
IP
What Taxing Distrid?
COUNTY AUDITOR
20 �_ 20 20
�°
County Auditor
Has this deduction been requested on
property for current yeaR 0 Yes � No
20
Date
20
/ We certify under the penalty of peryury that the above and foregoing informalion is true and corred and thal ihe applicants was / were
resident of Indiana and owner of the�aforementioned property on March 1, 20
ture owners full name)
O� ��
�sident address oi applicant %
/S . /' • � D.w,vQ F�S 11 i �/ @
7%
Person aulhorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
ofauthorized person