HomeMy WebLinkAboutMortgage_Beadles (3)ny
�,«.�
STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNEcc
FOR.DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (R5/4-03)
PrescnGeC Cy Departmeni of Local Govemment Finance
INSTRUCTIONS:
To be �led in person or by mail with the County Auditor of the county whe�e the property is located. _n Q�005
Filing Dates: 1) Real Property: During the 12 months be/ore May 11 of the year the deduction is ta�ePetfecfw
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 ot the year the deduction is to be effective.
See reverse side for additional instiuctions and qualifications. �Ja� ,���,
GIBSON COUNTY AUDITOR
Appli t(owner or co t 6uye - se stnctio n rever �de)
Taxing istrid Key number / le I description Record number �
� /� � O/� / �7� Page number �O�
L.J
Assessed value of.real property as of Mortgage / ContraG indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, cunent year March 1, current year owner? ❑ Yes ❑ No
(0 0O o'�
If no, what is his / her exact share of interest? if owned with someone other than spouse, indicate with whom.
if name on record is different lhan that of applicant, indicate below: Is the property in question:
❑ Real Properly ❑ Mobile Hane (IC &1.1-�
�ame of mortgagee or contract seller � C',�
Address of mortgagee or contract seller (number and street, city, state, Z!P
Name of assignee or other owner or holder of mortgage
Address of assignea (numberand st2et, city, state, ZIP code) -
Does applicant own property in any other If yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? property for current year? � Yes � No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �_ 20 �_ 20 � 20 20 20 20
P Q P
Signature County Auditor Date
�/ We certify under the penalty of perjury that the above and foregoing information is true and corred and thal the applicanls was�/ were
,a resident of Indiana and owner of the aforementioned property on March t, 20
Si nature (owners full name) Person authorized by duiy executed Power of Atlomey
� or by IC 6-1.1-12-.07
F II resident address of plicant Address of authorized person
/�� BLUJ ��A�� R,_�u; �� r.,�. �