HomeMy WebLinkAboutMortgage_GreenFORM 5
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
t � State FOrm 43709 (R3 / 10-00)
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� Presrnbe0 Ey State Board ot Taz Comrtussioners . --
. . -- JUL 0 �a�B�
Instructions far filing:
To be filed in person or by mail with the County Auditor of the county where the property is
located during the 12 moMhs before May 11 of the year the dedudion is to be effedive. See GIBSON COUMTY AUDITOR -
reverse side for additional insWCtions and qualfiptions.
Applicant (ow or contract b yer e strictions on 2Je side) �
Taxing District Key number / legal desuiption Record number .D I
o/�% —V��� / –Qv Pagenumber . �9-20
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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, curtent year owneR ❑ Yes � No
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If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
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If name on recard is different than fhat of applicant, indicate below:
� of mortgagee or contract seller I ,
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Address of mortgagee or contraG seller (number and street, city, state, ZIP� . , �
Name of assignee or other owner or holder of mortgage
Address of assignee (numbe� and st2et, aty, state, ZIP code)
Does applicant own real property in any If yes, what county? What Taxing DisVid? Has this deduction been requested on
other county in Indiana? property for current yeaR� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
zo ' zo � Zo Q/� zo �� zo 20 �z Zo �
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Sig ture OQ CountyAuditor Date
` e ceRify under the penalty of perjury that the above and foregoing informaGon is We and corred and that the applipnts was / were
ident of Indiana and owner of ihe aforementioned property on March 1, 20
Si nature (owners /ull name) Person authorized by dury exearted Power of Attomey
� or by IC 61.1-12-.07
Full resident address of applipnt Address of author¢ed person
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