HomeMy WebLinkAboutMortgage_Gaston (5)� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
` FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S" '/ State Fortn 43709 (RS / 4-03� �
�� Piescribed by Department of Lofal Govemment Finance
INSTRUCTIONS: OCT O 9 �tWMaric
To be Fled in person or by mail with the County Auditor o/ the county where the property is locat d. //
Filing Dates: 1) Real Property: Dunng the 12 months 6efore May 11 of the year the deduction i�o 6e e/(ecti�e. y�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o ar.t�{4e�io�-is��(fective.
See reverse side for addifional instructions and quali�cations. GIBSON COUN ��` AUDITOR I
O! COnt12Cf �DII}{B! - 5@Q
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Assessed value of real property as of
March 1, wrrent year
If no, what is his / her exad share of interest?
side)
Key number /Tegal description Record number Q�
�( q_� I�j ��% � D� Page number qo q�
I � 0
Mortgage / Contrad indebledness unpaid as of Is the applicant the sole legal or equitable
March 1, current year ownef? ❑ Yes ❑ No
�� 4 �
Ii name on record is different than that of applicant, indicate
If owned with someone other than spouse, indicate with whom.
�ame of moAgagee or contract seller //��� // // ^ A -/� r
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Address of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of moM1gage
Address of assignee (num6erand street, city, s[ate, ZIF
Is the property
❑ Real Property ❑ Mobile Home
Does applicant own property in any other If yes, what counry? What Taxing Districi? Has this deduction been requested on
county in Indiana? property for wrtent year? O YesO No
COUNTY AUDITOR
Deduclion approved in the amounl of: DTa�yeC N � • • ""' � � � � � � � � � � ..
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County Auditor
/ We certify under the penaliy of perjury lhal the above and foregoing infortnation is true and corced and thal the applicants was / were
resident of Indiana and owner of the aforemenlioned property on March 1, 20
full name)
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
address of applicant �Address of authorized person