HomeMy WebLinkAboutMortgage_Hale (2)� �� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i��i; FOR DEDUCTION FROM.ASSESSED VALUATION
:.. «. y State Form 43709 (R6l 5-061 '
� Presoibed by Departmenl of local Gwemment Finance
INSTRUCTIONS:
Count Township Year
JUL 0 3F''�1��`
To be filed in person o� by mail with the County Auditor of the county whe�e fhe property is located.
Filing Dates: 7J Real Properiy: Dunng lhe 72 months be%2 June 11 of the year the deduction is to be �ve. y' .
2) Mobile Homes assessed unde� IC 6-7.7-7: Between January 15 and March 2 0/ the yea �eteonq� to be effective.
See reverse side for additional insfnictions and quali(cations. GIBSON COUNTY qUDITOR
Applicant (o e ,contract buye - see restrictions on verse side)
Taxing Distrid Key number / legal description Record number
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current ar owneR ❑ Yes ❑ No
If no, what is his / her exad share ot interest? I owned with someone other than spouse, indicate wilh whom.
If name on record is different ihan that of applicant, indicate below: Is the property in question:
❑ Real Property p Mobile Home QC 61.1-�
me of mortgagee or contrad seller o
Address of mortgagee or contract seller mber and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand st2et, city, state, ZIP code) ^ �,/�N
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Dces applipnt own property in any olher If yes, what county? `.ion been requested on
county in Indiana? rent year? � Yes 0 No
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COUN '^'Q�O��
Deduction approved in lhe amounf of:
zo v� ' 2o a 2o zo 20 2o zo
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Signature County Audilor Date
�We certify under the penalry of perjury that the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on Marcti 1, 20
Sig alure (owners (ull name) Person authorized by duly executed Power of Attomey
_ � or by IC 6-1.1-12-.07
II resident a dress ot applicant Address of authorized person
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