HomeMy WebLinkAboutMortgage_Capehart�„ ,,.n
/e� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
s'�;FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
�
� �:� / State Fortn 43709 (R6I5-O6) �
�� Presrnbed by Deparimenl of Local Gwemment Finance
INSTRUCTIONS: �E�F`�e IZ1y�O6
To be /iled in pe�son or by mail with the County Audito� 0/ the county whe�e the propeRy is located.
Filing Dates: 1) Real Property: During the 12 months be(ore ,lune 17 of the year the deduction is to be effect� �
2J Mobile Homes assessed under IC 6-1.1J: Between January 15 and March 2 of the year the dede�c !6n �s o�be effective.
G�BSON COUN7Y qUD170H
See �everse side fo� additional instiuclions and qualifications.
Applicant(o orcont cfbuyer-.. -
�
Taxing Distrid
�i��-�
Assessed value of real property as af
March 1, curtent year
H no, whal is his / her exact share of
Key number / lega( description Record number
a�G /.2-0 ,�o3_aa�i.7a3-oab' G�Q9�O
�/��� �D 2'� Page number /
� °� �C>
Mortgage / Contrad indebtedness unpaid as of Is the applipnt lhe sole legal or equitable
March 1, current year ownef? ❑ Yes ❑ No
6.�C.�J I
If owned with someone other than spouse, indicate with whom.
If name on record is different than that of appticant, indicate below:
�me of moRgagee or contrad selier �/� • '
Address of mortgagee or contract seller (number and stie�l, , city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and streef, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? I What Ta
counry in Indiana?
Deduction approved in fhe amouni of:
20
Signature
20 `�
I
Is the property in question:
Real Property ❑ Mobile Horrie pC 61.1-�
!�� � .....
vra���er N�..
L:3�'-"' • .
Card ��• .... �� a�•......
� 90.�t7.� Sk
COUNTY AUDITOR
20 D 9 20 20
P
County Auditor
1, _ p_;'aQ.t:�° _ _ested an
�Ra•up'-- , .,� current yea(?0 Yes� No
20
Dale
20
We certify under the penalry of perjury that the above and foregoing information is irue and corred and lhal lhe applicants was / were
resideni of Indiana and owner of the aforemenlioned property on March 1, 20
l' // L, ,1 �+.�/ ; ( �' ��G
Full ydsident address of a plicant
� '�� � s- i%�j' ,J',��
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person