HomeMy WebLinkAboutMortgage_Gaines`° �° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
` � Stale Fwm 43709 (R4 / 10-07)
w.
� PresaibeA by Departmenl of Lccal Govemment Finance —
INSTRUCTIONS: � � t� • F.ile,Mark�
To be filed in person or by mail with the County Audifor of the county where the property is located.
Filing Dates: 1) Real PropeRy: During fhe 12 months be(ore May 11 of the year the deduction is to be �Jf�tn%�.6 ZQQ3
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 of the year the deduction is to 6e effective.
See reverse side /or additional instnictions and quali�cafions. �� �
�,,���, J , -�- ��%
������.��°.;��.�-„ �,�,�T�o I
Applicant (owner or confrac yer see restricti n reverse side �
Tauing Dislrid Key number / legal des 'ption Record number O�
D/���OOqbrb� Pagenumber
lJ �
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or quitable
March 1, current year MarcFi �ent year owneR ❑ Yes ❑ No
3ooc�
I( no, what is his / her exad share of interesl? � If owned with someone other lhan spouse, indicate with whom.
If name on record is dif(erent lhan that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ M�ile Home (IC 61.1-�
�ame of mortgagee or contract seller
�•1 ,C1�
Address of mortgagee or contrad seller (number and street, city, st e ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Dces applipnt own property in any other If yes, what county? What Taxing District? Has lhis deduction been requested on
county in Indiana? property for curtent yeaR 0 Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amounl of:
20 20 20 �% 20 .�� 20�� 20� 20
� p
Signature County Auditor Date
�'/ We certify under ihe penalty of perjury that the above and foregoing information is lrue and correcl and that the applicanls was / were
resident of Indiana and owner of the aforemenlioned property on March 1, 20
Si n e(ow ers I name) Person authorized by duty executed Power of Attomey
��f�y--� or by IC 6-1.1-12-.07
F I sident address of applipnt Address of authorized person
(03 wooD62EE Ow�r{Sv;���, Irl �-17665