HomeMy WebLinkAboutMortgage_McClanahan/e� �' � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
s' FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
� !+ State Form 43709 (R6 / 5-0G) 1 �
Presoibed by DeparUnent of Local Govemment Finance
INSTRUCTIONS: NOV O $ 20�� ^^a�x
To be /iled in person or by mail wdh the County Auditor of the county where fhe property is located.
Filing Dates: 1) Real Property: Dunng the 12 months before dune I1 0/ the yea� the deducGon is to_ae eBective.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of th�/��e��6on is to be etlective.
See reverse side for additional instnictions and qualifications. GIBSON COUNTY AUDITOR
or contracf 6u�-
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Tauing
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Assessed value of real property as of
March 1, current year
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Key number / legal description Record number
C_i8 a� �o�_Qao. oaa-Qaa S
O l /—b d�a0 '�� Page number
7� � 1.:
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or eq�
March 1, curtent year owneR ❑ Yes ❑ No
�Z�O O V �a fOD
If no, what is his / her exad share of interest? If owned with someone
If name on record is different than that of applicant, indicate below:
'me of mortgagee or contrad seiler
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Address of mortgagee or conVact seller (number and street, city, state, ZI !�
Name of assignee or other owner or holder oi mortgage
Address nf ���:�--• — - � , ZIP code)
QQS:z:77�
� DC1��'C►' �O� _ hatcounty?
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Card NO• . _._......
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-�,.,,,.�., �n me amount of:
20
Signature
20 _�
other than spouse, indicate with whom.
Is the property in question:
� Real Property ❑ Mobile Home pC 61.
What Taxing Distrid? Has this deduction been requested on
property for wrrent year?� Yes❑ No
COUNTY AUDITOR
20 � 20
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County Auditor
20
20
Date
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We certify under the penalty of perjury lhat the above and foregoing information is true and corred and that the applicants was / were '
residenl of Indiana and owner of the aforementioned property on March 1, 20
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Full resident ddress of appt
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Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
Address of authorized person