HomeMy WebLinkAboutMortgage_Coleman (2).+. °<n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�5��FOR DEDUCTION FROM ASSESSED VALUATION ���
Stale Fwm 43709 (RB / 2-07)
��' y„ � Presaibetl by Departmenl of Local Govemment Finarxe ��
INSTRUCTIONS: oE� �
To be filed in person or by mail wifh Me Counfy Audifor o/ fhe tounty where the property is located.
Fding Dates: 1J Real Property: DuAng the 12 months before June 17 0/ the year the deduction is lo.b�
2) Mobile Homes assessed unde� IC 6-1JJ: 8ehveen January 75 and Maroh 2 0! Ur�
See ieverse side !a addi6onal instruc6ons and qualifications.
GIBSON COU
n�re� -
Key number /
see)
/ � '
Assessed vdue of real paperty as o( March 1, amenl yesr Mor�page I(
wrtenlyear
�whal is his I her exad share ot inlerest?
If name m recwd is d'rfterent Ihan ihal ot applicant, iMinte below:
Nartre of mortgagee or cmUaG seller
rtaM1gagce or mn�racl seller (number antl sVee(.
signee w ather awrrer w hdder of mortgage
Address of assignee (number a�M sfreet. ciry, state, aM ZIP wtle)
Does applicanl own pioperty in eny olher
counry in Indiana?
❑ Yes ❑ No
Deduction appmved in the amwnt of:
20 � I 2b _ I 20
/ '�i1'Jf i
as of March i,
FCR
�Of
File a —
�, �7JQ-r� Auditor
is fo be eNe 6veGibson Counly
with sameone olher lhan spouse, indicate wiih whom.
2b � 20
a eqtnl2tAe owneYi
❑Yes ❑ No
he property in queslion:
Real Property ❑ Mobile Hpne QC 61.1
— ..0��`r" ' � /�l
�i•a�vCr �0•.... .
�t.��.�.�73��,,,� o0
�/,� y �
i
20 _
I/ We certify under Ne penalry of perjury tliat ihe above and foregoing infortrwtion is We and correct and that ihe applicants was 1 were a resident of
Indiana and owner ot the aforementioned property on March 1, 20 _
address
/
Z/P
w
person (number aM sfreeL aty. stafe. aM ZIP wde)
aay,