HomeMy WebLinkAboutMortgage_Robertsi:� A� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�: _ _ � State Form 43709 (R6 / 5-06)
Presvibed by Depanment M Local Gwemment Finance
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INSTRUCTIONS:
To be Tled in person or by mail with the County Audito� o/ the county where the p�operty is located. �C❑ 9 Z��$
Filing Dates: i) Real Property: During the 12 months be(ore ,lune Il of fhe year the deduction is to be �RbCtiv�
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o/fhe yea the deductio`n is to be eHective.
See reverse side fo� additional instructions and qualifrcations. c(�/ �a�(/
GIBSON COUN� A�Jp�TOR
Applicant (ovmeror
Taxing Dislrid
see resqiqtion� on r�rse side)
Assessed value of real property as of
March 1, wrrent year
what is his / her exad share of interest?
Key number / leg�lldescription Record number
U
a�p��� /a oZ�� /in� ��_� 9enumber
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Mortgage / Contrad indebtedness unpaid as of Is the appli
March 1, curtent year owneR
1 the sole legal or equitable
❑ Yes ❑ No
If owned wilh someone other than spouse, indicate with whom.
If name on record is different than tliat of applicant, indicate below:
e of moRgagee or contrad seller
Address of mortgagee or contrad seller (number and ree , city, state, ZIP
Name of assignee or other owner or holder oi mortgage
Address of assignee (number and sVeet,
Does applicant own property in any
county in Indiana?
Deduction approv
s[ate, ZIP code)
If yes, what county? � What Taxing Distrid?
Dra�ti�er N�.��a�.! V�� NTY AUDITOR
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20 � 5� j✓j�f� � !j� �'<,CJ .
P � -� � � � �
County Auditor
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❑ Real Property ❑ Mobile Horne OC 61.
Has this dedudion been requesled on
property for current yeaf? � Yes� No
�
Date
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certify under the penalty of perjury that the above and foregoing infortnation is true and correct and that ihe applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
. ��
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
:nt atltlress af applipnt Address of authorized person
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