HomeMy WebLinkAboutMortgage_Simmons� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUGTION FROM ASSESSED VALUATION Coun Township Year
'•. ! State Porm 43709 (RS / 4-03) � . � � � �
1� Presaibed by Department of Loral Govamment Finance
�
INSTRUCTIONS: APR �� ��6
To be filed in person or 6y mail with the County Auditor ol the county where the propeRy is located.
Filing Dates: 1J Real Property: During the 12 months be/ore May 11 0/ the year the deduciion is to 6e elfectiveII� ���
2) Mobile Nomes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year t� �edGtion islo beP Hective.
See 2verse side Ior additional instnictions and qualifications. GIBSON COUNTY AUDI70R
Taxing Dislrid
Assessed Jalue of real
March 1, curtent year
buyer
on reverse
Key number / legal
Record number O
b p S-v/ ba,� o� Fage number �O
as of Mortgage / ContraG indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owner? ❑ Yes ❑ No
If no, what is his / her exact share of interest?
If name on
that of applicant, indicate below:
moAgagee or contrad seller
a r�
owned with someone other than spouse, indicate with whom.
Address of mortgagee or contraIX seller (number and streef, city, state, ZIP
Name of assignee or other owner or holder of mortgage
(number and sheet, city, state, ZIP code)
Dces applicant own property in any other I If yes, what county?
county in Indiana?
What Taxing Distrid?
COUNTY AUDITOR
)edudic
Drawer N0...41.� •••••••••
Zo�' Card N0. ...� 7........ zo zo
� �'15�cc0 ��-9.�. c. u � �
Signature
County Auditor
Is the property in question:
❑ Real Properry ❑ Mobile Home QC 61.1
Has this dedudion been requested on
property for current year?� Yes❑ No
zo
�
We certify under the penalty of perjury that the above and foregoing information is true and corred and thal lhe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
full
Person authorized by duly executed
or by IC 6-1.1-12-.07
person