HomeMy WebLinkAboutMortgage_Elliott (3)�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Townshi Year
�'+ w� J State Fortn 43709 (R5 / 4-03) � �
� I P'asai6ed Cy Departmem of Loral Gcvemment Finance
INSTRUCTlONS: FEB 2 ��@��
To be filed in person or by mail with the County Auditor of the counry where the property is located.
Filing Dates: 1J Real Properry. During the 12 montAs before May 11 of the year the deduction is to be e7/ective.
2) Mobile Homes assessed under IC 6-1.1J: Between January 15 and March 2 of fhe yeay4%'ie� d��rXis to be eflective.
U
See reverse side for additional insfructions and qualiTcations. GIBSON COUNTY AUDITOR
Applicanl
buye�- see 2s%t 'c ons on
/J Q. / i
Taxing Distrid /
`�/�vx�-�
Assessed value oi real property as of
March 1, current year
no, whal is his / her exact share
If name on
than
of mortgagee or contrad seller
Ke number / legal description
a�/�-J� ��i'�S'-� ,
Mortgage / Contract indebtedness unpaid as
March 1, current year
of applicant,
of mortgagee or conVad seller (number and
Name of assignee or other owner or holder of mortgage
below:
Address of assignee. (number and street, city, state, ZlP code)
Does applicant own property in any other If yes, what counry?
county in Indiana?
Deduction
20
Signature
Record number
Page number � a� 6
f Is the applicant the sole legal or
owneR ❑ Yes ❑ No
owned with someone olher lhan spouse, indicate with whom.
state, ZIP
s the property in question:
❑ Real Property ❑ Mobile Home QC 61.
Dra�ver \TO����a "�a�6
— Card NO . .....................
What Taxing District? Has this dedudion been requested on
property for current yeart� Yes❑ No
COUNTY AUDITOR
in lhe amounf oi:
20�� 20 Oq 20 20
� P
County Auditor
20
Date
E{�]
�We certiy under the penalty of perjury that Ihe above and foregoing information is irue and corred and thal the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
� Signat�re (own � full name) Person authorized by duly executed Power of Attomey
.��; � I/ Ci�o� � o� by ic s-i.i-iz-.o�
FuII resident aAdress of appl'`c�ahY -`-� Address of authorized person
� '.3� � T�. C,\C` �U-2 " 1 ��...c ��s.� �