HomeMy WebLinkAboutMortgage_Corsentino/�� n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�'i�� FOR DEDUCTION FROM ASSESSED VALUATION
. � I State Form 43709 (R6 / SO6) -
PresQibed by Department of Local Govemment Finante
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Count Township Year
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INSTRUCTIONS: � � L 9�[�%Mark
To be liled in person o� by mail with the County Auditor o( the county where the p�operty is located. ��
Filing Dates: 1) Real Property. Dunng the 12 months be(ore June 11 of the year the deduction is to be��e,Q
2J Mo6ile Nomes assessed unde� IC 6-1.7-7: Between January 15 and March 2 of the� year the�iedu�n is to 6e elfective.
GIBSON COUNTY AUDITOR
See �everse side for additional instiuctions and qualifrcations.
Applicant
0
Assessed value qj real property as of
March 1, wrrent year
If no, what is his / her exad share of interest?
name on record is different than that
of mortgagee or contrad seller
side)
Key number / legal description I Record number Q`
OS
a�-D�-OG -3oo-oa3.i�
Mortgage / Contrad indebtedness unpaid as of
March 1, curtent year
indicate below:
t the sole legal or equitable
❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
Addtess of moRgagee or conVact seller (number and st2et, city,•state, ZIP
Name ot assignee or other owner or holder ot mortgage
(numberand street, city, state,
Dces appficant own propeRy in any other It /� O p S� N- 1.,5 A.� V
county in Indianal l.• ��
MICNAE � p
Susa� m
)educdon approved in the amount of:
20 20 20
P �
oa-�ac�3
�
County Auditor
20
❑ Real Property ❑ Mobile Home QC 61.1-�
Has this dedudion been requested on
property for curtent yea(? � Yes ❑ No
20
Date
20
Je certify under the penalty of perjury that the above and foregoing infortnalion is true and correct and that the applicants was / were
sident of Indiana and owner of the aforemenlioned property on March 1, 20
ature (owne�s full name) ^� Person authorized by duly executed Power of Attomey
��� �y� `i� , i '� or by IC 6-1.1-12-.07
�esident address of applicant Address of authorized person