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Mortgage_Beard
'��y ' FOR DE UCTIION ROM ASSES ED VAL IATION INDEBTEDNESS nt Tow p� \Year V �O ;�' State Form 43709(R10/11-08) , ` I tlx\. .--'/ Prescribed by Department d Loral Government Finance .�J� ll INSTRUCTIONS: JUN 2I J [UO9 To be filed in person or by mail Mth the County Auditor of the county where the property is located. 6 Filing Dates: 1) Real Property:Must Ide during the year for which the deduction is sought 2)Mobile/Manufactured Homes not assessed as Reel Property:Must file during the twelve(12)months fr Man trot each year the deduction is sought / CO Ok See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR Applicant(owner s buyer' on meld'e)f 1 ao District Key numbs / I`/`dl••(rY) tion R:•.. n u \ I,��1►�- o�(o- -s.77--- -lea- ©co. ?q�01 '� j 4.0 IP •• Assessed value of real property as of Monpage/Contract cdebledness unpaid as of Mortgage/Contract indebtedness unbend as of Is thee?plicant the sole •March 1,current year Mainly cunt 7t�ra _. date of appli®tion legal / v-J( t rL--Ji N/o If no,what is his/her exact share of interest? If owned with someone other Nan spouse,indcate with wtnm If name on record is dlfan>nt than that of app&mrd,indicate below: Is the property in question:Annually Assessed • Real Property ❑Annually Assessed Motile Home(IC 6-1.1-7) Name of mortgagee or contract seller 1 • t L Address of mortgagee a contract seller(number and street,�d4 state.and ZIP code) Name of assignee or other owner or holder of mortgage Address of assignee(number and sheet,city,state,and ZIP code) Does applicant own property in any other If yes,what county? What Taxing Dist d? Has this deduction been requested on property county in Indiana? ❑ Yes ❑ for current yyear? ❑ Yes Na ❑ No COUNTY AUDITOR Deduction approved in the amount at -. 20 20 20 20 20 20 20 Signature of County Auditor County Date(north,day,year) I/W- certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and It', /contract buyer of the aforementioned property on date application is filed. !/ u a s ) Date(month,day,year) • resident address of applicant(number and sheet,city,state.and ZIP code) • authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(mesh,day,year) Address of authorized person (number and street coy,state,and ZIP code)