HomeMy WebLinkAboutMortgage_Fox�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
++ �w� ! State Form 43709 (R5 / 4-03)
� Presai�ed by Department of Local Govemment Financa � T�
� ,i -�-� �
INSTRUCTIONS: File Mark
To 6e filed in person or 6y mail wiih the Counry Auditor o( the county whe�e [he property is located. a �� 2$ 2��6
Filing Dates: 1J Real PropeRy: During the 12 months be%re May 11 o/the year the deduction is to 6e effective.
2) Mobile Homes assessed under lC 6-1.1-7: Between January 15 and March 2 0/ the year,the deducUon is to be eHective.
v'!c� � U
See reverse side for additional instructions and qualifications.
GIBSON COUNTy qUDITOR
Taxing
��W,��, �, ��,u,cu uuyer - see resma�ons on reverse side)
� l.� �_ r, ' . , ,
py number / legal
�-/d•oi-y
ir.�L!�'
Assessed value of real property as of Mortgage / Contract ii
March t, curtent year March 1, wrrent year
� � s
If no, what is his / her exact share of interest?
If name on record is diHerent than that ot applicanf, indicate below:
of moRgagee or contraIX seller
of mortgagee or contrad seller
Name of assignee or other owner or holder of morigage
of assignee (number
Does applipnt own property in any
county in Indiana?
sUeet, city, state, ZIP code)
approvea in the amount ot:
20 � I Zp�
T
Signature
If yes, what counry?
Record nurt
8 �, p,i8
, Page numbi
�.ss unpaid as of Is the a
ownert
�
: legal or equitable
❑ No
If owned with someone other than spouse, indicate with whom.
stale, ZIP
What Taxing District?
COUNTY AUDITOR
20 �� 20 20
P
County Auditor
the
20
❑ Mabile Home (IC 6-1.1-�
: ,.
�YJ � l � -I
#{otl, $00. m
20
We certify under the penalty of perjury that ihe above and foregoing information is true and correcl and that the applicants was / were
�esident of Indiana and owner of the aforementioned property on March 1, 20
name)
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person