HomeMy WebLinkAboutMortgage_Harbison�'�� y STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
s' � FOR DEDUCTION FROM ASSESSED VALUATION vCount Township Year
' ��y. . J State Fam 43709 (R6 / 5-06) ■ . • � � �\
� Presoibed by Department of Local Govemment Finance �—� $i
INSTRUCTIONS: �UL O SF��ark
To be (iled in pe�son or by mail with the County Auditor ot the county where the property is located.
Filing Dates: t J Real Property: Dunng the 12 months before ,lune �f o/ the year lhe deduction is to be e F�
2J Mobile Homes assessed under lC 6-1.1-7: Between January 15 and March 2 of t GBSON COUN��DITOR effective.
See reverse side for additional instructions and qualifications.
(owner or contrdct
S��d � . : �
see restricfions on reverse side) �
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Key mber / legal description
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"�a�-07-.3�.3-��•�!3"' �9�umoer (
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the,sole legal or equitable
March i, wrtent year March 1, current year owneR ❑�Yes ❑ No
l D, OD�
If no, what is his / her exad share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is different ihan that of applicant, indicate below: Is the property in question:
mortgagee or conVad seller
Address of mortgagee or contract seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
(number and street,
Does appliwnt own property in any other
county in Indiana?
Deduction
20 �_ 20
�
Signature
fhe amouni of:
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(:UUN I Y AUUI I UFC
20 20 20
County Audilor
❑ Real Prop�iy ❑ Mobile Hmie QC 6-1.1-�
�.
Has this dedudion been requested on
property for current yeaR � Yes ❑ No
20
20
We certify under the penalty of perjury that the above and foregoing information is true and correct and lhat the applicants was / were
�esident of Indiana and owner of the aforementioned property on March 1, 20
full name)
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
address of ap nt Address of authorized person
11 1.� ) (-M.flin� I�iev� �t ! ?(o �l�