HomeMy WebLinkAboutMortgage_Graff�,r—•� 5 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
,,, .. : ; FOR DEDUCTION FROM ASSESSED VALUATION � � �
' Slale Fortn 43703 (RS / 2-07)
�� ;� 1 Presobed by DepartmeM of Local Govemment Finarice
iNSrnucnoNS: SEP 1 �'���`
To 6e filed in person or by mad wrfh the CountyAuditor ol the county where fhe propeRy is located.
F�7ing Dates: 1) Real Properfy Dunng the 72 months be%re June 71 of the year fhe deduction is to be elfecGve.
2) Mobile Homes assessed under IC 6-1.7-7: Between January 15 and Maroh 2 0/ the year the deduc6on���
See reverse side for additional insbuctions arid quali�cations.
� n GIBSON COUNTY AUDITOR
6uyu - see
what is his I her eract share of interesl?
If reme m recatl is different �han Ihat oF
Name of rtartgagee or contract
of rtarlgagee w mniraG seller
Ieverse
legal desai Reoord number Page number
�03 -cr,n./ SC� -oa � �
year Abrtgage / ConVaq indebledness unpaid as ot March 1, Is Ihe applipnt Ihe sde legal a equitaNe ame%+
�rt � � ❑Yes ❑ No
If ownetl wii1� wmeane dher Ihan spouse,'vitlicate wiUi whom.
of asvgrree ar otner owirer or ndaer o� monga9e
Atldress of assignee (rnim6er aM sheel, dty. sfafe,
Does applicant own property in arry ollier
courrtyin Indiana?
❑Yes ❑ No
Deduction appmve0 in Ue amount of:
20
Sig�Wre of Counry AudMr
20
eel. dty, stale. arrd ZIP code)
ZIP mde�
If yes, what counq? What Ta�ci�
I
� COUNTYAUDITOF
20 _ 20 _
Counry
Is
❑ MaMle Hmie
lli-a���er NO..O�1. . � �.[./
� `
- • . , , • . , a,wern
Card NO. �.r .... ............... ❑r,o
S'G3, o a C,l'i�.����„Q�
20
20
r.�
I I We certify under lhe penalty of perjury thal the above and foregoinq in(ortnation is We and corred and fhat the applirants was / were a resident of
Indiana and ovmer of ihe aforementirned propeAy on March 7, 20
��Wre (rnyrets (ull name) .. �, Date (rtronfh, daY• Yea�
Sf2e1, cdy. sfafe. aMl
0
of Attaney w by IC 61.142-.07
Address of aNhw¢ed persor� (numbe� alM sLeeR �Y. state.
Date (month, day yean