HomeMy WebLinkAboutMortgage_Duguid� � STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
�a�' � FOR DEDUCTION FROM ASSESSED VALUATION .
\. . -� • State Form 43709 (R6 / 5-06) '
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Prescribed by Deparimenl of Local Govemment Firiarxe
Coun Township Year
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INSTRUCTIONS: SEP — 4 �}�a�
To 6e tiled in person o� by mail with lhe County Audito� o/ the county where the p�opeRy is locafed. �
Fi/ing Dates: 7) Real Property: Dunng the 72 months before ,lune Il of the year.the deduction is to 6e e�' ,Q
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o(the year the�ducti 1nhe eKective.
See reverse side lor additional instructions and quali�cations.
GIBSON COUNTY A I70Ft
(owner or contract
Dislrid
see resMctions on
number / legal
Record number
�vo �
Page number � p� O
0
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, current year owneR ❑ Yes fl No "
� ld3 550 �ii-ia-,o3-oodiv�-a�
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
�me of mortgagee or contraIX seller � �
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Address of mortgagee or contract seller (num er and sfreet, ciq�-°'-'--"--
Name of assignee or other owner or holder of mortgage
(num6er and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
county in Indiana?
Deduction :
20 ��
1
Signature _
I_��""%
COUN �
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in the amount of:
20 OS_ 20 20 �
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County Auditor
We certify under the penalty of perjury lhat the above and forego,
�esident of Indiana and owner of the aforemenlioned property on I
natu owner's /ull name)
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do� (.<l
s lhe property in question:
❑ Real Properiy ❑ Mobite Home QC 61.1
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Person authorized by duly exewted Power oi Attomey
or by IC 6-1.1-12-.07
authorized person _
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0