HomeMy WebLinkAboutMortgage_Dau� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
- '° FOR DEDUCTION FROM ASSESSED VALUATION
S / State Fortn a3709 (R4 / 10-07)
��� Frewibed by DepaMient W Local Govemment Finance
INSTRUCTIONS:
Coun Township Year
File Mark
To be filed in person or by mail with the County Auditor o/ fhe county where the praperty is located. %�P R`� 9 ZQ02
Filing Dates: 1) Real Property: During the 12 months belo2 May 11 0l the yea� the deduction is to be eHective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 31 0/ year the d du on is t e ective.
See reverse side (or addifional inshuctions and qualifications.
GIBSON COU 7Y AUDITOR
Assessed value of real property as of
MarcFi 1, current year
If no, what is his / her exad share
restnctions on re�eYse side)
number / legal description
Mortgage / Contrad ii
March 1, curfe,�t year
name on record is different than that of applicant,
of mortgagee or contrad selier
of moAgagee or contrad seller (number and
of assignee or other owner or holder of mortgage
of assignee (numberand sbeet, city, sfate, ZIP code)
Does applicant own property in any other I If yes, what county?
county in Indiana?
20
approved in the amounl of:
20 �
Record number
Page number
as of Is the applicant the sole legal or equitable
owneR ❑ Yes � No
owned wilh someone other than spouse; indicate with whom.
ZIP
Whal Taxing District?
COUNTY AUDITOR
20 �� 20 �,� 20
�
County Auditor
�
property in queslion:
❑ Mobile Home QC 61.1
Has this deduction been requested on
properiy for curtent yeaR❑ Yes❑ No
�
Date
1� 20 ��
� �
certify under the penalty of perjury that the above and foregoing information is true and corred and that lhe appticants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly execuled Power of Attomey
or by IC 6-1.1-12-.07
�611 residSnt add of applicant Address of authonzed person
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