HomeMy WebLinkAboutMortgage_Aubuchong�'� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i = FOR DEDUCTION FROM ASSESSED VALUATION
� � / State Form 43709 (R6/5-06)
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\ Presaibed by Oepenment of Loral Gwemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Audito� ol the counfy where the property is located. AP R 2 6 Z���
Filing Dates: 1) Real Property: Dunng the 12 months before June 11 of the year the deduction is to 6e eflective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduction is to be ef(ective.
See reverse side �or additional instructions and qual�cations. p��a-� ��+�
GIBSON C UNTY UDITOR
Applicant (owne� o contrect 6uyer - see res rictions on reverse side)
Taxing DisVict Key number / legal description Record number Q
D ' I�� � _ D) _ � , Page number � �
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Assessed value of real property as of Mortgage / Contract indebtedness unpaid of Is the applicant the sole legal o equitable
March 1, current year March 1, current year owner? � Yes � No
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if no, what is his / her exact share of inte2sY? If owned with someone oiher than spouse, indicate with whom.
IT name on record is different than that of appiicant, indicate below: Is the property in question:
❑ Real Property O Mobi7e Home QC G1.1-7)
�i mortgagee or contract seller ' /
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Address of mortgagee or contract seller (number and strset, city, stafe, ZIP
Name oi assignee or other owner or holder of mortgage
Address oi assignee (numberand street, crty, state. ZlP code)
Does appliqnt own property in any other Ii yes, what county? Wha[ Taxing District? Has this deduction been requested on
county in Indiana? property for wrrent year? ❑ YesO No
COUNTY AUDITOR
Deduction approved in the amount of:
20�� 20�� 20� 20 20 20 20
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Signature County Auditor Date
I/ W certity under the penalty of perjury that the above and foregoing infortnation is We and cortect and that the appiicants was / were
dent of Indiana and owner of [he aforementioned property on March 1, 20 .
aiyr�ture (ow ers full name) Person authorized by duly executed Power ot Attomey
��� or by IC 6-1.1-12-.07
Full residen�ress of plicant Address of authorized person
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