HomeMy WebLinkAboutMortgage_Lange��� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
' = FOR DEDUCTION FROM ASSESSED VALUATION
.�.«. y Stete Fwm 43709 (R6 / 5-06)
Presaibed by Department of Lowl Gwemment Finance
Coun Township Year
� ��
AP� � � 2007
INSTRUCTIONS: il� a
To be filed in person or by mail with the CountyAudito� of the county where the property is located.
Filing Dates: 1) Real Property: Durtng the 12 monYhs before ,lune 11 0/ the year the deduction is to be e/fective. %�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the yea� the deduc6o�s�b�Rective.
QIBSON COUNiY AUBIfi6�
See reveise side for additional instructions and qual�caUons.
see
Key ndmber /
�t� a� - a,��-��- F
Assessed value oi real property as of Mortgage / Contract indebtedness unpaid as of
March 1, current year March 1, current year
� ?_ Jb0
no, what is his / her exact
name on
of mortgagee or contract
applicant, indicate below:
of mortgagee or contract seller (number and
or omer owner ar
Does applicant own pmperty in any
county in Indiana?
city,
number Q
number
Is the applicant the sole legal or equitable
owner? ❑ Yes � No
someone other than spouse,
Is the property
❑ Rea� P�oper
whom.
❑ Mob�7e Home QC G1.1-7)
�f m� �U� �
'�},/`�� (�, - aa��,
�, 5t `�'�:_,{"�Z`° /^� . ^
G (� ^ � / I �
— 0 7� .S �� •� C:��i�{(�
yes, l Has this deducdon been requested on
Q/yl� property for current year? ❑ Yes❑ No
COUNTY AUDITOR
)eduction approved in the amount of:
20� 20 4� 20 0 20 20
� � �
iignature County Auditor
20
Date
20
Je certify under the penalty of perjury that the above and foregoing infortnation is true and correct and that the applicants was / were
sident of Indiana and owner of the aforementioned property on March 1, 20
or by IC 6-1.1-12-.07
otauthorized person