HomeMy WebLinkAboutMortgage_Phillips (4)iJ ^H
� � � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'a' FOR DEDUCTION FROM ASSESSED VALUATION
�u.
�J State Fartn 43709 (R6l 5-06) ' ' '
� Presaibed by Department of Loral Govemment Finarxe
INSTRUCTIONS:
Coun Township Year
OCT 1 5F��6'��
To 6e filed in person or by mail wdh the County Audito� o/ the coun[y where the property is located.
Filing Dates: 1) Real Property: Dunng the 12 months before June 11 of the year the deduction is to 6e e ve. �{
2) Mobile Homes assessed under IC Sl. f-7: Between January 15 and March 2 0/ the yea th �Gc6� to be elfective.
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
�
Appli t(ownerorcont�act buyer- see res 'ou on reverse side)
C'
Taxi Distrid Key nu ber / legal description Record number �� D/
f°
��t,</-�✓�� oC G"OY- � S' I D� - QOO. .39.3 - page number � 7 d.S
O �. D
Assessed value of real property as of MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March t, current year March 1, currenl year owneR ❑ Yes ❑ No
3a,9o�
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on retord is difterent than that of applicant, indicate below: Is the property in question:
O Real Property ❑ Mobile Home (IC 61.1-�
�me of morigagee or contrad seller
s/3
Address of mortgagee or contract seller (number and street, city; state, ZIP •
Name of asaignee or other owner or holder of mortgage —
Dra�►�er1\*O.p,P? 0 6
Address of aasignee (number and street, city, state, ZIP code) �. .. ..: ,��a f"
Card i�Tp, . �
Does appC�nt own property in any other If yes, what wunty? WI •••......., equested on
county in Indiana7 � � � � "' � �] Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 � 20 �_ 20 20 20 20 20
\
Signature County Auditor Date
�'/ We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
esident of Indiana and owner of lhe aforementioned property on March 1, 20
Signature (avners /ull n e) Person authorized by duly executed Power of Attomey
`. �':� � � '/' ) or by IC 6-1.1-12-.07
/ �GG :J�/
II rebidenl address of appliqnt ' Address of authorized person
,�U �