HomeMy WebLinkAboutMortgage_Goddard� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSEO VALUATION Coun Township Year
� / State Form 43709 (R5 / 4-03)
�M�
� P25cribed by Department of Local Govemmeni Finance �
INSTRUCTIONS: � File M �j
To be filed in person or by mail with the CountyAuditor o(the county where the property is located. QCT �`Z, Z�y�+
Filing Dates: 1) Real P�operty: During the 12 months before May 11 of the year the deduction is to be efiective. /�
2J Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the ar the ded ctioh to be�'ehe ive.
See reverse side for additional instructions and qualifications.
GIBSON OU�TY �UDIiOR
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buyer- seq'r¢strictions on
Kp�,humber / legal description Record number ��
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole Iegai or e
March t, current year March 1, current year ownei'? ❑ Yes ❑ No
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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: Is the property in question:
of mortgagee or contract seller J�
Address of mortgagee or contract seller (number and street,
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Does appticant own property in any other If yes, what county?
county in Indiana?
Deduction approved in fhe amount of:
r� I � � /
❑ Real Properry ❑ Mobile Home (IC Cr1.
Drawer Np . . ested on
/� • • ���� Yes❑No
Card i\rp, , v � - � . ��J
couNrr a
20 20 0 20
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County Auditor
20 V y 20
, �
Date
/ We certify under the penalty of perjury fhat the above and toregoing informalion is true and corred and that the applicants was / were
i resident of Indiana and owner of ihe aforementioned property on March 1, 20
name)
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
FuII resident address o�p�pnt . �Address of authonzed person