HomeMy WebLinkAboutMortgage_Carey (3)��� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
� J State Fortn 43709 (R6 / 5-061
Aesaibed by Department ot Laal Gwemment Financa
wsrRUCnoNS:
To be filed in person or by mail with the Counfy Auditor of the county where the propeRy is located. �� �Y 1 S 2���
Filing Dates: i) Real Property: During the 12 months before ,lune 11 0/ lhe year the deduc6on is to be eflecti��b"
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduc6on is to be effective.
See 2veise side for adddional instiuc6ons and qualifrcaGons. ,i �r �� ��G
. GIBSON COUNTY AUDITOR
(owner or cont2ct buyer -,9'eeJrastnctions on
Taxing
legal
�' OO 7
n/ l'1�0�� �. 2i 1-0 �e number �� g�
d�D-ro� .�7i
Assessed value of real property as of Mortgage ! Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, current year owner? Q Yes Q No
� J.`-� `� V
I( no, what is his / her exact share
If name on record
of mortgagee or contract
of
of mortgagee or contract seller (number and
owner or
Does applicant own property in any
counry in Indiana?
20 �_
Signature
r ot mortgage
:ity, slate, ZIF
Ii yes, what c
owned with someone other than spouse, indicate
question:
I❑ Real Properiy ❑ Mobile Home QC 6�1.1-7)
w ' W -
�
city, slate, ZIP ��
j ��Y�� a L �, � , �
�z.--�.: �� ,, 3
9) /7 _ - �—�}` � ,�'�'�
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What Taxing District?
COUNTY AUDITOR
in the amount oi:
20 �� 20 � 20 20
� p
Counry Auditor
Has this deduction been requested on
property for current year? Q Yes❑ No
�
Date
�
certify under the penalry oT perjury ihat the above and foregoing infortnation is true and conect and that the applicants was / were
lent oi Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person