HomeMy WebLinkAboutMortgage_Clevenger (3)f.�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
's� c FOR DEDUCTION FROM ASSESSED VALUATION
•.... N.� State Fwm 43709 (R6 / 5-06) '
Presaibed by DeparUnent of Lonl Govemment Finance
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Coun Township Year
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INSTRUCT/ONS: F�i�y,�q aric
To be /iled in person or by mail with the County Auditoi of the couniy whe�e the property is located. � AN 2 5 LUU I�
Filing Dates: 1) Real Property: Dunng the 12 months before June Il of the year the deduction is to be effective.
2) Mobile Homes assessed under lC 6-1.1-7: Between January 15 and March 2 of the year the deductiog, is fo be eSective.
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See reve/Se side fo� additiona/ instluctions and qualifications. GI6SON COUNTY AUDITOR
restrictions on
Assessed value of real property as of
March 1, current year
no, what is his / her exact share of interest?
If name on record is different than that
of mortgagee or contrad seller
Key number / legal description J
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number � /
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�/ C O _ Page number �/ � �
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Mortgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, current year owneR ❑ Yes ❑ No
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If owned with someone other than spouse, indicate with whom.
indicate below:
Address of moRgagee or wntrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand street, city, state, ZIP co
Is the property in question:
❑ Real Property p Mobile Home (IC 6-1.1-
Does applicant own pronAµ '__-� —� �} /- y? What Taxing Distrid? Has this dedudion been requested on
coun in �^"�
lY d" I�R � property for current year? � Yes � No
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Dra���er �� . •
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Signature
�UNTY AUDITOR
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County Auditor
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Dale
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We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
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resident address of applicant
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Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Address of authorized person