HomeMy WebLinkAboutMortgage_Carrolli i��'� 1 STATEMENT OF MORTGAGE OR CONTRACT INDE6TEDNESS
'�i' = FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
� Stale Fortn 43709 (R6 / SO6) 0�
� Presaibetl b y De p artment of Local Gavamment Finarxe �
INSTRUCTIONS: OCT O 9 2()tl�Mark
To be filed in person or by mail wrth the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months 6elore ,lune 17 of the year the deduction is to ective. �i�
2J Mobile Nomes assessed under IC 6-1.7-7: Between January 15 and March 2 of the�Areul�t�n is to be elfective.
C/ U
See �everse srde foradditional instnictions and qual�cations. „ GIBSON COUNTY AUDITOR
contrac( buy�r, - see
Assessed vatue of real property as of
March 1, aurent year " �
If no, what is his / her exact share
If name on
ieverse
number / legal description
Mortgage / Conlrad ii
March 1, curtent year
than ihat of applicant, indicate
or conVaG seller
Address of mortgagee or contrad seller (num`6er and st�eet, city,
Name of asaignee a other owner or holder of mortgage
Address
and street, city, state, ZIP code)
Record number �Q��
�� Page number � �
unpaid as of Is the applicant the sole legal or
ownef? ❑ Yes ❑'No
If owned wilh someone other than spouse, indicate with whom.
s the property in question:
❑ Real Property O Md�ile Home pC 61.
Does applicarM own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiarta7 property for current yea(? 0 Yes ❑ No
�o�Nr�„�_-- - a98.�
Deduction approved in the amount of: , � O �,!'�.'• �••""
D�•a�ver �0�...
F�!� � ' " �
�
Signature
�
Counq
Card ��• ..................... _ I zo
Date
We ceRify under the penalty of perjury lhal lhe above and foregoing information is true and corred and that the appticants was / were
Vesident of Indiana and owner of the aforementioned property on March 1, 20
applicant
Person authorized by duiy executed Power of Attomey
or by IC 6-1.1-12-.07
Address of authorized person