HomeMy WebLinkAboutMortgage_Turner��� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�. ✓ State Fwm <3709 (R5/ d�03)
� N PrescnDeE by Department of Loral Gpvemment Financa
INSTRUCTIONS:
To be liled in person or by mail with the County Auditor ol the county where the property is located.
Filing Dates: 1) Real PropeRy: Dunng the 72 months belore May 71 of the year the deduction is to be e1�ctive. s Z005
2) Mobile Homes assessed under IC 6-7.7-7: 8etween January 15 and Marcn 2 o/the year fhe deduction is to be effective.
See reverse side /or additional insfructions and qualifications. ��.6�
G�BSON COUNTY qUDlTpq
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Applicanf
Taxing District� "
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number / legal
y� O�— /�D �� � –Et1T� Page number
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Assessed value of real'droperty as.of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year March 1, wrrent year owner? ❑ Yes ❑ No .
u�DnDv
Ii no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on rewrd is different than that of applicant, indicate below: Is the property in question:
mortgagee or contrad seller
Address of mortgagee or wniract seller (number and street, cify,
or other owner or holder of mortgage
of assignee (number and street, city, state, ZIP
Does applicant own property in any other I If yes, what counry?
county in Indiana?
appro
20
Signature
�,�A at�Y ��u R� E K-
e 3� �.3as
Q
IWhat Taxing District?
UDITOR
20
P
County Auditor
❑ Real Property ❑ Mobile Hwne (IC 61.1
Has this deduction been requested on
property for current year?� Yes� No
20
Date
20
.We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners�(ull name)
7esident address ofappliiant N'jb�
K>R�21 13oY.7z- i-�'�-�r.`Sro ��i
Person authorized by duly execuled Power of Attorney
or by IC 6-1.1-12-.07
Address ofauthorized person