HomeMy WebLinkAboutMortgage_Bicevshi'"� R.',°u�
; ia � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
n'�' FOR DEDUCTION FROM ASSESSED VALUATION
� s J State Fortn 43709 (R6 / S-06) '' '
Prwaibed by Department of Loml Gwemment Fi�nce
INSTRUCTIONS: '
To be /iled in person or by mail with the CountyAudito� ol the county where the property is located. � r T� s Z���
Filing Dates: 1) Real Pioperty: During the 12 months 6efore June �f o/lhe year the deduc6on is to b�H�c e.
2) Mobile Homes assessed under IC 6-.1.1-7: Between January 15 and March 2 of fhe y@ar th� �� is to 6e eilective.
See �everse side fo� additional instructions and qualifications. �
G�BSON COUNTY AUDITOR
ApPlicant`(ownerorcontra yer- see restrictions on rev_ eye� side) • �
�1
Taxing Distrid Key number / legal descriplion I
, ' I
`� .�, � aG-/� o7-�/d� .,a� <
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of
March 1, current year March 1, ent year
' ����n ��
If no, what is his / her exact share of interest?
If name on record is different
of mortgagee or contract selier
indicate below:
number
owneR
�
�$8U
�nc me soie iegai or
�es ❑ No
If owned with someone other lhan spouse, indicate with whom.
Address of mortgagee or contrad seller (number and st�eef, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number
Does applicant own property in any
county in Indiana?
DeducGon approved in the amount of:
20 � I 20
Signature
I�
❑ Mobile Home
state, ZIP code) / � ���� �- �* �, �,.�„Q�t�
�. � yd'� 0 o.ro
r If yes, what county? What Taxii
COUNTY AUDITOR
20 20 20
County Auditor
L—:_����
20 , • 20
�,
�tl on
❑ No
\�'
We certify under the penalry of perjury lhat the above and foregoing infortnation is true and corred and lhat the applicants was ! were
resident of Indiana and owner of lhe aforementioned property on March 1, 20
nam�
Person authorized by duty exewted Power oi Attomey
or by IC 6-1.1-12-.07
w�ucm aawcaa v� eyyuwm Haaress or aumonzea person
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