HomeMy WebLinkAboutMortgage_Peek (4),..�R--•n
ia6 "', STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'i��; FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
��• �«..% StateFwm43709(R6/5-W) . . .
� Presaibed by Departmeni of Local Govemment Finance �� �
INSTRUCTIONS: OCT G ���Q�
To be /iled in person or by mail with the County Auditor of fhe counfy whe�e the property is located.
Filing Dates: 1 J Real P�operty: Dunng fhe 12 months 6e(o2 ,lune il of the year the deducUon is to be e�/;� e.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0l the year 9ie`����o be efiective.
See reverse side /or additional insVuctions and quali/ications. GIBSON COUNTY AUDITOR
Distrid
or contract buy�e/r-�see res/tr�ictions on
'i.('1.t� ILS! • /!�i /'/S
,
Assessed value of real property as of
March 1, current year
Ii no, what is
exact share of interesl?
name on record is different ihan that
side)
Key number / lega� description F
��-�.a.-a�.-,ioa-ooa F
soa- oa 8
MoAgage / Contrad indebtedness unpaid as ot
March 1, wrrent year
55, ooa
indicate below:
>rd number D —7
!
; number � � r D
Is the applicant the sole legal or
owner? ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
of mortgagee ntract seller
�°7. �. C.u.
>s of mortgagee or conVad selier (number and streef, city, state, :
Name of assignee or other owner or holder of mortgage
assignee (numberand st2et, city, state,
Does applicant own propeRy in any other I If yes, what wunty?
county in indiana?
Deduction approved in the amounl of:
20 � 20 �� 20
P
Signature
couNrr,
20
County Auditor
R
❑ Real Property ❑ Mobile Home pC 61.
' � Q��.
�. I. FC_ �.(.
�Y SS� l�(�l
�07-� �I i�
Dale
;ed on
> ❑ No
' We certify under the penalty of perjury that the above and foregoing information is lrue and corred and that the applicants was / were
resident of Indiana and owner of lhe aforemenlioned property on March 1, 20
�nat/uren (owners full name) Person authorized by duly executed Power of Attomey
�-('Y � . n �i /�. . � _ _ or by IC 6-1.1-12-.07
appliwnt
s� Nn,�
Address of authorized person