HomeMy WebLinkAboutMortgage_Jones (6)STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
� � State Fwm 43�09 (R5 / 4-03)
� Prestribad �y Departmt•M of Laal Govemment Firence
INSTRUCTIONS:
To be filed in person or by mail wifh the County Auditor of the county where the property is located.
Filing Oates: 1) Real Property: During the 12 monfhs 6efo�e May 11 of fhe year the deduction is to be�e8ectii[e 4 2�05
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduction is to be etiective.
See reverse side !or additional instnictions and qual�cations. '�jl_� � f,�u�
� A . GIBSON COUNTY UDiTOR
Assessed value oi real property�as of
March 1, current year
/ —�-
If no, what is his / her exact share of interest?
on reverse side)
Key number / legal description � Record number
� / _ O � � �� Page number — �
MoAgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitabie
March t, current year owneR ❑ Yes ❑ No
If name on record is different than that of applicant, indicate below:
of moAgagee or contraIX seller
If owned with someone other than spouse, indicate with whom.
Address of mortgagee or cont.ad seller (number and st�eet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and stieet, ciry, state, ZIP code)
Does applicant own property in any
county in Indiana?
Deduction approved in the amounl o
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Signature
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- "-�^' ^^'���v? � What Taxing Distrid?
Dra�ver ��'p..: a� r"J
Card NO. .... �a 7 � % —
l,l�rr� .iI 51,800...... —
- — �`- '�latsla5 —
P I �
County Auditor
Is the property in queslion:
❑ Reai Property ❑ Mobile Home pC Crt.
Has this deduction been requested on
property for curtent yeaf? � Yes ❑ No
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Date
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We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
�esident of Indiana and owner of the aforementioned property on March 1, 20
fu/ll name)
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y
Person authorized by
or by IC 6-1.1-12-.07
Address of authorized person
of
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