HomeMy WebLinkAboutMortgage_Haas'e�"� STATEMENT OF MORTGAGE OR CONTRACT ItvGtBTEDNESS
i` ", FOR DEDUCTION FROM ASSESSED VALUATION
�•• «. -! Stata Form a3709 (R6 / 5-06) � � ,.
� Presaibed by Depanmenl of Loral Gwemrtrent Finance
INSTRUCTIONS:
To 6e /iled in person o� by mail with the County Auditor o/ the county whe�e the property is located.
Filing Dates: 1 J Rea/ P�operty: Dunng the 12 months before ,lune I7 of the year the deduction is to be effecti� �] 9 ZQQ%
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and Ma�ch 2 of the yea� the deduction is to be eflective.
See reverse side for additional instructions and qualifications. �� ,a�
1
GIBSON COUNTY AUDITOR
contiacf buyer �see
n/ f
Ta�cing Distrid
m
number / legal description � Record number
- -[/ 'U(J - ./ 7J-C/d d
Assessed value of real property as of Mortgage / Contract ir
Marrh 1, curtent year March 1, currenl year
If no, what is his / her exact share of interest?
1
If name on record is diNerent than that of applicant, indicate below:
or contreG seller
Page number
unpaid as ot Is the applicant the sole legal or equitable
owner? � Yes ❑ No
owned with someone other than spouse, indicate with whom.
Address of mortgagee or contract seller (number and street, city, state,
Name of aseignee or
Address of essignee
�
Does a
counry
owner or holder ot mortgage
(num6er and street, city, state, ZIP code)
�-'"°' ��f �PS. what county? I What Taxing Dislrid?
'1
Dra�ser i\'O.:�i`�,1�, % -�.�87
COUNTY AUDITOR
— y, Card i\'p, „
Dedu �� g �T��
20 o A / G�� 20 �� 20 20
� �
Signature County Auditor
Is the property in question:
❑ Real Property ❑ Mobile Hmie (IC 6-1.
Has this dedudion been requested on
property for current yeaR �] Yes ❑ No
20
Date
20
certify under lhe penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
(owners /ull m
: addressC�
�v 0,3 '� �
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person