HomeMy WebLinkAboutMortgage_GonyerSTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION
S J Stale Fofm 43709 (R4/10-01)
�«.
/ Prescribed by Department of Local Govemmeni Finance
INSTRUCTIONS:
To be filed in person or 6y mail with the County Auditor of the county whe2 the property is located. ���
Filing Dates: 1) Real PropeRy: Dunng the 12 months be(o2 May 11 0l the year the deduction is to be e7fectiv 6 Z003
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 of-the year the dedu'ction is.to bs effective.
See reverse side for additional instructions and qualifications. �..
„ GIBSON COUNTY FUDITOR
Applicant
Assessed value of real property as of
March 1, current year
on reverse
Key number / legal description u Record number Q
�I l•/ ^ QO j_ ��� Page number
� -I l0
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current Year owneR ❑ Yes ❑ No
If no, what is his / her exact share of interesl? I( 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:
❑ Real PropeAy ❑ Mobile Home QC 61.1-�
�ame of mortgagee or contrad seller
Address of mortgagee or wnVad selier (number and st �, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6erand street, city, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Taxing Distrid?
county in Indiana?
COUNTY AUDITOR
Deduction approved in the amount of:
20 O �' � 20 �,�
20 Q� 20 O I 20
� P
County Auditor
Has this deduclion been requested on
property for curtent yeaR � Yes ❑ No
20 0 9 � 20
P �
Date
certiTy under the penalty of perjury that the above and foregoing infortnation is true and corred and lhat the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
executed Power of Attomey
or by IC 6-1.1-12-.07
4ddress of authorized person
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