HomeMy WebLinkAboutMortgage_Starnes`°�'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-' : FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
S �� Slate Fofm 43709 (R4 / 70.01) ��� f�l
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� Presaibed Dy Departmenl of Local Govemment Finance {��,
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INSTRUCTIONS: A�� ��M�2
To be filed in person or 6y mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months belore May 11 of the year the deduction is to 6 effectiv
2) Mobile Homes assessed under IC 6-1.1-7: Beiween January 15 and March 31 0/ thg���6�lfi�(i� �is�� ctive.
� GIBSON COUNTY AUDITOR I
See ieverse side (or additional instructions and qualifications.
Applicant (owner or contract buyer- see 2strictions on reverse side)
Taxing Distrid Key number / gal cription Record number ��
` D I Q� Pagenumberg
Assesse alue of r I property as o MoAgage / Contrad indebtedness unpaid as of Is the applican�sole legal or equitable
March 1, currenl yea March 1, wrrent year owne(? es ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicanl, indicate below: Is the property in question:
I Property ❑ Mobile Home QC 61.1-�
me of mortgagee or contract seller
Addr s of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? property for current yeaf? � Yes� No
COUNTY AUDITOR
Deduction approved in the amounl of:
zo �_ zo D zo zo Q(� 20 o zo � zo �y
i� Ja �
Signature County Auditor Date
�i / We certify under the penalty of perjury lhat the above and foregoing information is lrue and corred and that the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners full name) Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
Fu resi t ad ess of a plicant Address of authorized person
/r/ 6.Y 4�t1.� r.s' c