HomeMy WebLinkAboutMortgage_Pepmeier�
,' ,.� /
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 63709 (RS / 4-03)
Presaibe0 by Depanmeni ot local Govemmem Finance
Coun Township Year
._ � -,7� ? ', i,-'-�
� �
� '� r + � �
_a �j. e'_ � �,,..: t_
�RUCTIONS: File Mark
To be (led in person or by mail with the County Auditor of the county where the property is located. -_� �:, tuuJ
Filing Dates: 1J Real Property: During the 12 mon[hs belore May 11 0/ the year the deduction is to be eflective.
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o�f,the yea�r t—h�e deduction is�to be effective.
See reverse side for additional instructions and qualificafions. /o "%'���`""�
GIBSON COUNTY AUDITOR
Taxing District
value of real property as
March 1, curtent year
If no, what is his / her exact
on
Address
mortgagee or contract
restnc ons on v rse si )
� � �
Key number / legal description
/ 7 --b��3 S-�a
Record number
aaga�
Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, cur ent year owner? ❑ Yes ❑ No
�S000�
If owned with someone other than spouse, indicate with whom.
ate below:
v I J
of mortgagee or contrect seller (number and street,
assignee or other owner or holder of mortgage
st�eet, city, state,
Does applicant own property in any oiher I If yes, what
counry in Indiana?
Deduction approved in the amount of:
��'��/Ti.' '�
state, ZIP
s the property in questian:
❑ Real Property ❑ Mobile Home (IC 61.1-7)
Drawer NO..G °?,;; �� 9�-
Card 1�i0 . .....................
�
Counry Auditor
: deduction been requested on
y for current year? 0 Yes❑ No
•� � - ' •' fil
�
I/ We certify under the penalry of perjury that the above and foregoing information is true and correct and that the applicants was I were
a resident of Indiana and owner of the aforementioned property on March t, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
address of appliFant Address of authorized person
'-� �ii 2 U/ �%. , �o.r.¢.c.t�i .._Gh �l 7G (05