HomeMy WebLinkAboutMortgage_Pease`°�° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'e "° : FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S � � J $tate Fortn 43709 (R4 / 10.01) � ' ��
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� Prescribetl by Departmenl of Loc�al Govemment Finance 0
wsrRUCrioNS: F E g�;ie r,,�}g3
To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1J Real Prope�ty: During the 12 months 6elore May 11 of the yea� the deduction is to effective. /]
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 of th r the J�Jrt� i o e eft�'ctive.
See reverse side for additional instnictions and quafifica6ons. GIBSON COUNT Y AUOiTOR �
Applica wperorcontract 6uyer- s stri ons on re e side)
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Taxing istrid number / Iegai description Record number
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_[�y , Q/ � � j� � _ �� Page number �/� J
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Assessed v lue of real property as of Mortgage ! Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current r owneR ❑ Yes ❑ No
If no, what is his / her exact share of interest? If owned wilh someone other lhan spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: is the property in question:
� � ❑ Real Property ❑ Mobile Hwrie (IC 61.1-n
�ame of mortgagee or contract seller t �
Address o( mortgagee or contrad seller (number and st2 t, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
couny in Indiana? property for current year? � YesO No
COUNTY AUDITOR
Deduction approved in the amounl of:
zo Zo zo 20 20 � za � 2o a
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Signature County Auditor Date
I/ We certiy under lhe penalty of perjury lhat lhe above and foregoing infortnation is true and correct and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
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Signatu�e� (ownels full name) Person authorized by duly execuled Power of Attomey
. i_�/ "� �`'1���� �� or by IC 6-1.1-12-.07
�resident addres's"of applicant Address of authorized person
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