HomeMy WebLinkAboutMortgage_Denbo�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
ti+ �w� ! State Fortn 43709 (RS / 4-03) . �
�� Prescn�ed �y Department of Loral Govemmeni Finance
INSTRUCTIONS: QP�'�� ^la�005
To 6e filed in person or by mail with the Counry Auditor of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months be%re May 11 0/ the year the deduction is to be effect ^��j� _�v'
2J Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 2 o(the year the ��ed9t�Rmrrvs�ge eRective.
See 2verse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
(owner or
Taxing Distrid
��,/ f +
buyer-
Assessed value of real property as of
March 1, curcent year
If no, what is his / her exact share
on re �erse side)
Key-aembeA legal description Record numbe��
D/ � ` Q � � � ��!'y1 Page number '"'
� tiC/
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or
March 1, current year _ owner? � ❑ Yes ❑ No
If name on record is diHerent than that of applicant,
���e of moAgagee or contrad seller �
Address of mortgagee or contraIX seller (number and
Name of assignee or other owner or holder oi mortgage
assignee (numberand street, city, state,
If owned with someone other than spouse, indicate with whom.
below:
city, state, ZIP
code)
Does applicant own property in any other If yes, what wunty? What Taxing District?
county in Indiana?
approved in fhe amount of:
20 �(� 20
Signature
e certity unde%r �t
;sident of Indfana a
�
COUNTY AUDITOR
20 �� 20 �� 20
� p
County Auditor
Is the property in question: .
❑ Real Properiy ❑ Mobile Home QC 61.1-�
Has this deduction been requested on
property for current year? �] Yes❑ No
20
20
penalty of peryury that the above and foregoing informalion is true and corred and thal lhe applicants was / were
�d 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
person