HomeMy WebLinkAboutMortgage_Berry (3)�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Townshi Year
� «• / State Porm 43709 (RS / 4-03) . . . . . .
PfeSCnDeC by Department o( Laal Gtivemment Finarxe �
INSTRUCTIONS: File Maric
To be filed in person or 6y mail with the CountyAUditor o/the county where the property is Iocat��,N 2 3 20�6
Filing Dates: 1) Real Property: During the 12 months belore May i 1 0) the year the deduction is to 6e eHective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o(tde,,,year th� dsduction is to be effective.
See reverse side for additional instn�ctions and quali�cations.
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GIBSON COUNTY AUDITOR
(owner or con6act buyer - see�tfic�ons on
Taxing D' rict
Assessed value of real properry as of
March 1, wrrenl year
what is his / her exad share of
If name on
Key ny(ntJer7legal
Record number
v� / /- DD/�5-� Pagenumber �/��
MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or e
March 1, current year ownef? ❑ Yes ❑ No
:.• lC���7'�.
than that of app�icant,
moAgagee or contraG seller
Address o( mortgaaee or rn�f��r+.==���-.�-•.-��__.__� _._ _.__
of assignee
Address
Does appllcant ow.
county in Indiana?
Deduction approved
20 O
�
Signature
Dra��•er NO���.�.9..���
Card NO . .....................
amount of:
� a:
, _ .._..,..,. ��r:
Ii owned with someone other than spouse, indicate with whom.
ZIP
What Taxing District?
COUNTY AUDITOR
zo 0 9 2a zo
PCounty Auditor
Is the property in question:
❑ Real Property ❑ Mobile Hane (IC 61.1
Has this dedudion been requested on
property for current yeaRQ YesO No
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Date
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We certify under the penalty of perjury that the above and foregoing information is true and corred and lhat the applicants was / were
resident ot Indiana and owner of the aforementioned property on March 1, 20
(owners�/ull name)
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Person authorized by duty executed Power of Attorney
or by IC 6-1.1-12-.07
Address ofauthorized person