HomeMy WebLinkAboutMortgage_Horralli�� � STATEMENT OF MORTGAGE OR CONTRACTINUEBTEDNESS
'i'� FOR DEDUCTION FROM ASSESSED VALUATION
�! • Stata Fortn 43709 (R6 / S-06) � � -
� Presaibed by Department of local Govemment Finance
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INSTRUCTIONS: File Mark
To 6e (iled in person or by mail with the County Audito� of the county where the p�operty is locafed. 0 � T 1 2 2�� ]
Filing Dates: 1) Real Property: Du�ng the 12 months before June Il of the year the deduction is to be eftective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year t��c�o 6e elfective.
See reverse side fo� additional instructions and qualitications. GIBSON COUNTY AUDITOR
Applicant
Taxing
buyer�
side)
Key number / legal description I Record number �/1 �
(/
l I�i�,{�, b—b�%'�/"'p��a'b[X%•l% Pa�e��umber 3i'TS
D O
Assessed value af real property as of Mortgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
Marrh 1, curtent year ' March 1, current year owneR ❑ Yes ❑ No
�O �O
It no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record fs different than that of applicant, indicate belo�
�e of mortgagee or contract seller
Address of mortgagee oc contrad seller (number and�
Name of assignee or ofher owner or holder of mortgage
ZIP
Address of assianee (number.and.street ary, state, ZIP code)
Doesapp DraFVerN�.�Y.4!�•.•�•T.7•I �y� WhatTaxingDistrict?
county in
CardNO . .....................
:OUNTY AUDITOR
approved in the amount of:
20 �_ 20
�
Signature
� 20 I 20 20
P
County Auditor
s the praperty in queslion:
❑ Real Property ❑ Mobile Home pC 61.
Has this deduction been requested on
property for wrrent yea(? 0 Yes ❑ No
20
Date
�
certify under lhe penalty of perjury that the above and foregoing information is true and corred and that Ihe applicants was / were
ient of Indiana and owner of the aforementioned property on March 1, 20
Signature
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Fuil resident address of appliqnt �Address of authorized person