HomeMy WebLinkAboutMortgage_Derr; �,� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
�l • State Fwm 43709 (R6 / 5-06) ' � - '
� Presaibed by Department of Loml Govemrtrem Finance
wsrRUCnoNS: JUL 1 6��2���`
To be Jiled in person or by mail wrth the County Auditor of the county where the p�opeRy is located. ' �
Filing Dates: 1) Rea/ Property: Dunng lhe 12 monlhs befo2 ,lune I1 0/ the year the deduction is to be eff
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 of fhe year tl��l�� be eRective.
See reverse side for additional instructions and quali(ications. GIBSON COUNTY AUDITOR
(owner
�
see
side)
�•
I axi Dislnd / Key number / legal description � Record num6er
1 �-OU �
�<�W /-N` �'1� oZ �o -Q�{-a �-.300 -1�00, ���-� Page number L{ �- g/
Assessed value of real property as of Mortgage / Contred indebtedness unpaid as of Is the applicant the sole legal or equitabte
March 1, curcent year March 1, current year ' owneR " ❑ Yes' ❑ No
/� ��V�U
If no, what is his / her exacl share of interesl? Ii owned with someone otfier than spouse; indicate with whom.
If name on record is different lhan that of applicant, indicate below: Is the property in question:
of moAgagee or contract seller
Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or
Address
owner or holder of mortgage
(number and stieet, ciry, state, ZIP code)
Does applicant axn property in any other If yes, what counry?
county in Indiana?
Deducfion approved in the amount of:
zo � zo �� 20
P
Signature
couNrr
20
County Auditor
FC c-r
❑ Real Property ❑ Mobile Horne pC Cr1.1
� ��0��_ ��.� 7
Whal Taxini (, �� �
I1/ � a�Q ��_
�/ ��Z, 600. �a
C , p7�a /"c �
We certify under the penalty of perjury lhat the above and foregoing information is true and corred and that lhe applicants was 1 were
esident of Indiana and owner of the aforemenlioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person