HomeMy WebLinkAboutMortgage_Harbison (9)��l�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Count Tovmship Year
�/• State Fartn 43709 (R6 / 596) �
� Presoibed by Depariment of Local Govemmem Finance
INSTRUCTIONS: .JUN ���q ��
To be filed in person or by mail with the County Audifor of the county where lhe property is located.
Filrng Dates: 1) Real Property: Dunng the 12 months before ,lune !1 of the year the deduction is to be effe�/ /�v
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 0( fhe year th�"dB�'6tt (J't�be eflective.
See reverse side lor additional instrucG'ons and quali(ications.
GIBSON COUNTY AUDITOR
Applica t(o ner or contract buyer- see re tn �iens on reverse side �
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Taxing Distriq mber / legal description Record number �bo �
/[/ G�� I��� OQ I d 7I Go� � Page number 3 � 5 9
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Assessed value of real property as of MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March t, curcent year March 1, wrrent year ownef? ❑ Yes ❑ No
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If no, whaf is his / her exact share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different ihan tF�at of applicant, indicate below: Is the omc�.t� �^ ^• •--"--
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me of mortgagee or contrad seller . .. �°
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. ......
Address of moRgagee or contrad selier (number and st , city, state, ZIP ��9
CeCd N�. . �•�•S'li5�a9....
Name oi assignee or other owner or holder of mortgage
Address of assignee (num6er and streef, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for curtent yearl � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 � 20 �_ 20 � 20 20 20 20
1 /
Signature County Auditor Date
'/ We certify under lhe penalty of perjury lhat the above and foregoing information is true and corced and lhal ihe applicants was / were
residenl of Indiana and owner of the aforementioned property on March 1, 20
Signature (ownefs full name) Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
Full reside addre ss of appl/ic)a,,nt Address of authorized person
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