HomeMy WebLinkAboutMortgage_LoeschSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
\ « Sfata Fortn 43709 (RS / 4-03)
� PresaiDed by Departmen! of Lo�l Govemment Finance
� ��
INSTRUCTIONS: �ile�Maric .
To be (led in person or 6y mail with the CountyAudiror ot the counry where [he property is located. �J yl �___,�+
Filing Dates: 1) Real Property: During the 12 months be%re May 11 0/ the year the deduction is to be effective.
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the dedl�h �, t�b�(�ctive.
See reverse side for additional instructions and quali�cafions.
�� ��
Applicant (o n ror contract buyer- see ies ions on reve se side) GIBSON COUtiTY A.UDiTOR
Ta�cing Di ri Key number / legal description Record number ��
I�/.M Q/1� ,O (1� I^� Page number
�c/ " , .� o� �a
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole leg or equitable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
• 5 , Dv
If no, what is his / her exad share of interest? If owned wilh someone other than spouse, indicate with whom.
. obC,- �
If name on record is different than that of applicant, indicate below: s the property in question:
❑ Real Property ❑ Mobile Horrie pC 61.1-�
�me of mortgagee or contrad seller '- �_�
� Ul B � ���,�,-�j
Address of mortgagee or contraq seller (number and st2et, city, state, ZIP 'Lt'"[ /I �
� d��C�J
Name of assignee or other owner or holder of mortgage
�5- %10,3
Address of assignee (number and st2et, city, state, ZIP code)
Does applicant own property in any other If yes, what county? Whal Taxing District? Has this dedudion been requested on
counly in Indiana? property for current year?� Yes❑ No
COUNTY AUDITOR
Dedudion approved in the amounl of:
20 20 �_ 20 � 20 20 20 20
V �Q
Signature County Auditor Date
e certify under the penalty of perjury that lhe above and foregoing informalion is true and corred and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
ig ature wne/s II name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Fui re ' ent ad ress of ap ipnt Address of authorized person
/.2 .�' i�f ,� a,� l.v