HomeMy WebLinkAboutMortgage_Gonzales (3)�a� j STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
1s'�` FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
`� �� J SUte Form 43709 (R6 / S-06)
� Presaibed by Depariment of Lopl Govemment Finance � � k
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iNSrRUCnoNS: DEC 2 S��y�a�
To be filed in person or by mail with the CountyAuditor o/ the county where lhe property is located.
Filing Dates: 1) Real Property: Dunng [he 12 months be%re ,lune Il of the year the deduction is to be �
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the ye r th �d�tiobris to be elfective.
See �everse side for additional instructions and quali(ications. GIBSON COUNTY AUDITOR
Applicant (owner
Taxing Distrid
see resmcuo s r reverse slue)
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Key numbe I gal des 'p '
-�a•� .. a.o3. cei.roS'p:
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Assessed value of real property as of
March 1, curzent year
If no, what is his / her exact share of interest?
If name on rewrd is different ihan lhat
of mortgagee or contraG
Record number O �
Page number ,/�/� �
.�
Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owneR ❑ Yes ❑ No
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If owned with someone olher than spouse, indicate wilh whom.
Address of mortgagee or conVad seller (number
Name of assignee or other owner or holder of mortgage
ciry, state,
Address of assignee (number and street, city, state, ZIP code)
Doesr►r,-- -----------°----"--.�.,--...._._--�ry? �WhatTaxingDistrict?
counh ,
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Dedu Card N� . .....................
20 �Z
Signature
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COUNTY AUDITOR
20�_ 20 20
P
County Auditor
❑ Real Properiy ❑ Mobile Home pC 61.1
Has this deduction been requested on
property for wrcent year? Q Yes ❑ No
20
Date
20
I/ We certity under the penalty of perjury thal lhe above and foregoing information is true and corred and that the applicants was / were
a resident ot Indiana and owner of the aforementioned property on March 1, 20
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Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
4ddress ofauthorized person