HomeMy WebLinkAboutMortgage_Donnell�e� � 4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
j\� = FOR DEDUCTION FROM ASSESSED VALUATION
`�. � -Y �ale Form 43709 (R6 / 5-06)
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Presvibed by Department ol Local Gwemment Finance
INSTRUCTIONS:
To be filed in pe�son or by mail with fhe County Audito� o/ the county whe�e the property is localed.
Filing Dates: 1) Real Properiy: Dunng lhe 12 months before June I7 0/ the year lhe deduction is to be e/fedfiLDl 1 O 200%
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0( the year the deduction is to be elfective.
See �everse side (or additional instnictions and quali�cations. �'Jj6� ��
GIBSON COUNTY
Applican o erorcontract buyer- see restri tions on reverse side)
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Taxing Distrid Key number / �egal description Record number v D�
�n � � -�a -o�,- aa3-oao; iss-oa �
i " a� 9- o a �� 5-� o Page number 7 7� 2.
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Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curcent year March 1, currenl year owner? �Yes ❑ No
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If no, what is his / her exad share of interest? If owned wifh someone other lhan spouse, indicate wilh whom.
If name on record is diflerent ihan that of applicanl, indicate below: Is the property in question:
�Real Property ❑ Mobile Home (IC 61.1-�
me of mortgagee or contract sel er �
Address of mortgagee or conVact seller (number nd street, ciry, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Does applicanl own property in any olher If yes, what county? What Taxing District? Has this deduqion been requested on
county in Indiana? property for current year?� Yes� No
COUNTY AUDITOR
Deduction approved in the amounl of:
20 D' 20 O q 20 20 20 20 20
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Signature County Auditor Date
! We certify under the penalty of peryury lhat the above and foregoing information is true and corred and ihat lhe applicants was / were
a resideni of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners (ull name Person authorized by duly executed Power of Attomey
x �_— � or by IC 6-1.1-12-.07
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Full resident address of applicant Address of aulhorized person
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