HomeMy WebLinkAboutMortgage_DarnellSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
/� w� / State Fwm 43709 (RS / 4-03) , �
�� PrescnDed by Department of Loral Gtivemment Finance
wsrnucrioNS: APR �ile�+�806
To be fileil in person or by mail with the County Auditor ol the county where the propeRy is located.
Filing Dates: 1) Real Property: Dunng the 12 months be%re May 11 0/ the year the deduction is to be e/%ctive.
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year tbe �ite6or�f��e effective.
See reverse side for addilional instructions and quali�cations. GIBSON COUNTY AUDITOR
buyer
Assessed value of real property as of
March 1, currenl year � � �
16 no, what is his / her exact
If name on record is different than that of
on reverse
Key number / legai description Record number ['^
� � J "�'
� ' Pa e number � ; ';
��q- � �o-.. 9 �� g3
Mortgage / Contract indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 1, current year ownef? ❑ Yes ❑ No
g�,o�
If owned wifh someone other than spouse, indicate with whom.
below:
moAgagee or contrad seller � � � �
of mortgagee or contract seiler (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
assignee (number and s12et, ciry, state, ZIP code)
Does applicant own property in any other I If yes, what counry? What Taxing Distrid?
county in Indiana? � �
� Deduction approved in the amount of:
20 v I
1
SignaWre _
r r:
COUNTY AUDITOR
20 � 20 20
� County Auditor
❑ Real Property ❑ Mobile Hortie pC 61.1-
Has this dedudion been requested on
propeAy for current yea(? � Yes ❑ No
20
Date
20
We certiry under the penalty of perjury that the above and foregoing informalion is true and corced and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March t, 20
�
o(
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
authorized person