HomeMy WebLinkAboutMortgage_Gardner (3)rt�n FORM 5
� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Filing fee 5t.0o
-- : FOR DEDUCTION FROM ASSESSED VALUATION
•, � Sfate Form 43709 (R / 12-99) Coun Township Year
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Prescribed by State Board ot Tax Commissioners
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InsVuctions for filing:
To be filed in person or by mail wilh the County Auditor of lhe county where the property is
located during the 12 monihs before May 11 of the year the dedudion is to be effective. See
reverse side for additional instructions and qualifications. GIBSO�' COUhTY AUDITOR
Applicant ner or ont t buyer - see restrictions on re� e side nw �fn
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Taxing Dislrid Key mber / legal description Record number
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Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March t, current year March 1, current year owneR ❑ Yes ❑ 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:
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�ame of mortgagee or contract seller
Address of mortgagee or contrad selier (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand street, city, state, ZIP code)
Does applicani own real propeRy in any If yes, what county? What Taxing District? Has this deduction been requested on
other county in Indiana? property for current yeaf? � Yes� No
PROPERTY TAX ASSESSMENT BOARD OF APPEALS
Deduction approved in the amounl of:
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Signature � Seaetary of PTABOA Date
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I/ We certiy under Ihe penalty of perjury that the above and foregoing information is true and corred and lhat the applicants was / were
resi ent of Indiana and owner of the aforementioned property on March 1, 20
i ature (owners full name) Person aulhorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Fu resid t a dr s of piicant Address of authorized person
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