HomeMy WebLinkAboutMortgage_Burton (6)i��q � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'i' � FOR DEDUCTION FROM ASSESSED VALUATION _ Count
v. w/ Stare Form 43709 (R6 / 5-06) �
� Prescribed by Department of Local Govemrtrent Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county whe�e the property is locat�
Filing Dates: 7) Real Property: Dunng the 12 months before June Il of the year the deduction is to be effective.
2) Mobile Homes assessed unde� lC 6-1.1-7: Between January 15 and March 2 of the yeaAthe,d�d�
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See reverse side for additional instnictions and qualifrcations.
:
Assessed value of
March 1, curtent yE
buyer-
property as of
If no, whal is his / her exact share of
Key number / legal description
ab-as-�y �oo-oa
Mortgage / Contrad indebtednes
March �1 c7urrent year
'W! i .�: , � r��r-�
GIBSON
`
�
Year
i� �
be e/fective.
Record number �
�� e number (���
�-
d as of Is the applicant the sole legal or equitable
owneR ❑ Yes � No "
If owned with someone other than spouse, indicate with whom.
If name on record is dif(erent than that of applicant, indicate below:
�me of mortgagee or contract seller
Address of mortgagee or contract seller (number and ` 6eet, city, stafe, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant
county in Indiai
aoo 7 ����
Deduction approvi ���-� /J diyl �--
I � l.,�cR'�"�
zo� I �3 ���
Signature � � /'/
I /v Cv/ ��' � a I
•_.-;
Taxing Distrid?
R
20
s lhe property in question:
❑ Real Properiy ❑ Mobile Home pC 61.1
Has this dedudion been requested on
property for curtent yeaR �] Yes � No
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We certify un� I information is true and corred and that the applicanls was / were
esident of IncL irch 1, 2p
j�ature (owne/s Iull name) �, �� ) � Person authorized by duly executed Power of Attomey
r ���[ait.�/�� o� by ic s-i.�-iz-.o�
�2Lr1
i'resid�nt ad ss of applicant Address of authonzed person
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