HomeMy WebLinkAboutMortgage_Robb (6)..� rt.�•
/� �� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
= FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�•' _ .y State Form 43709 (R6l 5-06)
�� Presaibed by Oepertment af Loral Govemmenl Finance
INSTRUCTIONS: NOV V'��"�06
To be filed in person o� by mail with the CountyAuditor ol the county where the property is located. .�
Filing Dates: 1J Real PropeRy: Dunng the 12 months 6efoie ,lune � 1 oI the yea� the deduction is to be eflective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o/the year th��i��be effective.
See reverse srde for additional instiuctions and qual�cations. GIBSON COUfNTY AUDITOR
Applicant (o r or conhacf buyer- see ' i s on reverse side) �
SF
Tauing Distrid Key numb r/ legal descripti Record number
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�j O/�, /}� � ��� Page number � ^
o.� y
Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, wrrent year March 1, current year owneR ❑ Yes ❑ No
If no, what is his / her exact share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different than Ihat ot applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home pC 61.1-�
me of mortgagee or contrad seller �
Address of mort ee or conUact seller (numb and street, ci te, ZIP
— � -
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this deduc[ion been requested on
county in Indiana? property for wrrent yeaRQ Yes❑ No
COUNTY AUDITOR
Deduction approved in the amounl of:
20 � 20 20 Q 20 20 20 20
P P �
Signature County Auditor Date
We certify under lhe penalty of perjury thal lhe above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
� Si ature (owners full a e Person authorized by duly execuled Power of Attomey
r or by IC 6-1.1-12-.07
Fu esid " t ad ess of applipnt ��-fio K Address of authorized person
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