HomeMy WebLinkAboutMortgage_Goodloe� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
1 ! Stata Form 43709 (RS / 4-03) .
�, PresaiEeE by Deparimem of Local Gtivemmant Finance
INSTRUCTIONS: �
To be filed in person or by mail with the Counry Auditor of the county where the property is located. I A�J 1 3 2��3
Filing Dates: 1) Real Property: During the 12 months before May 11 01 the year the deduction is to be eli€ti"ve.
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 2 of t e year the deduction is to 6e effective.
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See reverse side (or addiUonal instructions and qualifications. �,✓ ��w ��
� GIBSON COUNT�' �uDIiOP.
Applicant (o er or contract buyer- see strictions on erse side)
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Taxing i irid Key number / legal description Record number
� � Page number �O �
�/9- ��%-� � cb
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, currenl year owneR ❑ Yes ❑ No
, /�3, ao�o
If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than lhat of applicant, indicale below: Is the property in question:
❑ Real Prope�iy ❑ Mobile Home (IC fr1.1-�
me of moAgagee or contract seller ,
,
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Address of mortgagee or contrad seller (number and 5t2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applipnt own propeAy in any other If yes, what counry? What Taxing Distrid? � Has lhis dedudion been requested on
county in Indiana? , property for currenl yeaf? O Yes � No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �,� 20 20 �� 20 _� 20 �� 20 20
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Signature County Auditor Date
We certify under the penalty of perjury lhat the above and foregoing infortnation is true and correct and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners /ull name) Person authorized by duly exewted Power of Attomey
or by IC 6-1.1-12-.07
Full resi nl address applicant Address of authorized person