HomeMy WebLinkAboutMortgage_Newlin� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�'. ��� ! Siate Fortn 43709 (RS / 4-03)
� Prescn�ed Dy Department ol Local Govemment Financa
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Coun Township Year
II,E
iNSrRUCnoNS: .�@lnn9�3 2005
To 6e �led in person or 6y mail with the County Auditor ol the county where the property is located.
Filing Dates: 1) Real Property: Dunng the 12 montbs befo2 May 11 of the year the deduction is fo be eflective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the ded c i �ective.
See reverse side for additional instructions and qualifrcations. GIBSON COUNTY AUDITOR
Applicant nerorcontractbuyer�
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Taxing Disirid
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Assessed value of real property as of
March t, wrrent year
If no, what
/ her exact share of interest?
on
side) n ,
Key numbef / legal description � Record number
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�/ . �/ S�[1�U Page number
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Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year ownef? ❑ Yes ❑ No
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owned with someone other than spouse, indicate with whom.
If name on record is different ihan that of applicant, indicate below:
�me of mortgagee or conlrad seller D
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Address of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or olher owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any olher If yes.—`-' -^���N?_ � What Taxing District?
county in Indiana? -- — — _
;. Dra wer NO. a� y.. .....
Deduction approved in lhe amount ot: Card N�. .,, "`�Q
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20 // /n I 20 [1 pl I 20
Signature
P I2o R
County Auditor
Is the property in question:
❑ Real Property ❑ Mobile Home QC 61.
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Has this dedudion been requested on
property for wrrent year? � Yes � No
zo
Date
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We certiy under the penalty of perjury that the above and foregoing information is true and corred and lhal the applicants was l were
`esidenl of Indiana and owner of the aforementioned property on March t, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Full resident address of a plicant � Address of authorized person
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