HomeMy WebLinkAboutMortgage_Carroll (4)���Oa
/ei '�' 4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'i'�!,���$;,��r FOR DEDUCTION FROM ASSESSED VALUATION , Count _ Township Year
"•.��+ Siate Form 43709 �R6 / 596) '
� M Presaibed by Depanment of Laal Gwemmenl Finance �
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INSTRUCTIONS: File Mar1c
To be (iled in person o� by mail with !he CountyAuditor o1 fhe county whe�e fhe property is Iocated,JUN Q � ZQQ7
Filing Dates: 1) Real Property: Dunng the 12 months be%re June 11 0( the year the deduction is to be eBective. . .
2) Mobile Homes assessed under IC 6-1.7-7: Between January 15 and March 2 of the��� ��� on is to be effective.
See reverse srde for additional instructions and qualifications.
_ GIBSON COUNTY AUDITOR
or,yrontiact buyer
Assessed value of real property as of
March 1, wrrent year
If no, what is his / her exact share of interzsi?
If name on rewrd is different than that
of mortgagee or contrad seller
on rev,e�i e side)
�ey number / legal descriplion / Record nu lf
�!O ��Q / �0.3 �. �%Y Page m er �.J �� )
MoAgage / Contrad indebtedness unpaid as of I th applicant the sole legaf or equitable
March 1, current year o n. � ❑ Yes ❑ No
, .
If owned with someone other than spouse, indicate with whom.
Address of mortgagee or contrad s€Iler (number anast2et,
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2ef, city, state, ZIP coc
below:
Does applicant own property in any other If yes, what county?
county in indiana?
Dedudion appro� ed in the amount of:
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Signature
ZIP
Is the property in question:
❑ Real Property p Mobile Home QC 61.1-
WhatTaxin �)1"II\�'Cl'��`^�•T•�""-��� =don
❑ No
COUNTY AUDITOR
20
County Auditor
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C771'(1 �� . .....................
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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 correct and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
�✓v1.3-U
Full resident addre6s of
Person authorized by duly executed Power of Attorney
or by IC 6-7.1-12-.07
of authorized person