HomeMy WebLinkAboutMortgage_Koberstein (3)� i� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�' FOR DEDUCTION FROM ASSESSED VALUATION
! • Stala Form 43709 (R6/ 5-06) �
� Presaibed by Department of Local Govemment Finance
INSTRUCTIONS:
To be filed in pe�son o� by mail with the County Audito� of the county where the property is located.
Filing Dates: 1) Real P�operty: During the 12 months before �une l7 0/ the year the deduction is to be ef/ectiii%N 1 1��� �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduction is lo be eflective.
See ieverse side fo� additional instructions and qualifications. aaaU��� �
GIBSO�VUNTY AUDITOR
Applicant (owner or contract buyer - see restrictions on reverse side) ,
Taxing District Key n mber legal description Record umber
� , ac�-la-c��..ao�-aaa,
^ 6 Page number 5 �� �
Assessed value of real property as of MoRgage / Contred indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owneR �es ❑ No
/
lb�
If no, what is his / her exad share of interest? I owned wilh someone other fhan spouse, indicate with whom.
If name on record is differenl ihan that of applicant, indicate below: Is the property in queslion:
eal Property ❑ Mobile Home QC 61.1-�
me of moAgagee or contred seller
-5
Addre s of mortgagee or conirad seller (number and st2et. city, state, ZIP
Name of assignee or other owner or holder of mortgage '
Address of assignee (number and street, city, sfate, : q y
D►•a�vcr NO..J.�.-.`S.y.Q• �'
Does applicant own property in any other If yes, wha; � lhis deduction been requested on
county in Indiana? � i �rty for current yeaR � Yes ❑ No
C�1'(i �0 . .....................
COUNTY AUDITOR
Dedudion approved in lhe amounl of:
20 �� 20 �� 20 � 20 20 20 20
� � P
Signature County Auditor Date
We certiy under the penalty of perjury lhal lhe above and foregoing information is true and corred and thal lhe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signat (owners /ull n e) Person authorized by duly executed Power of Attomey
• or by IC 6-1.1-12-.07
Fu resideoa d� s of ap`pli nA ^_ � Address of authorized person
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