HomeMy WebLinkAboutMortgage_Matthews (2)`"rt�° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�'`- E FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
Slate Form 43709 (R4l 70.07) " " � �� �j'��
� 'a. � � �i
PrescribeE by DepaNnenl of Local Govemment Finance
INSTRUCTIONS: MAR 6Fit�2�rk
To 6e filed in person or by maii with !he County Auditor of the county whe2 the property is located. 2
Filing Dates: 1) Real Property: During the 12 months be/ore May 11 of the year the deduction is to-be effective. l
2) Mobile Homes assessed under IC 6-1 J-7: Behveen January 15 and March 31 o(t6e yean iledu� 1'on is t0 be eflective.
See reverse side for additional instructions and qualifications. GIBSON COU�'-`•' '""' `�
(ownerorcontract buyer- see restrictions on 2verse
� � Pr��, �e-t-� h
Assessed value of real property as of
March 1, wrrent year
ILno, what is his / her exact share of inierest?
If name on record is different
moAgagee or conlrad seiler
Key number / legal description
'o �9 �Od 76� �—PID
Mortgage / Contract ir
March 1, curreni year
1 1 r�' ,/1 � /I
of applicant, indicate
�'�,-I'e� 6�A %SG( v� K lV .f
Address o( m gagee or contrad seller (number and
of assignee or other owner or holder of mortgage
of assignee
2 �5
Record number' �2 ' �
J
Page number
unpaid as of I Is the applicant the
owneR �
legal or equitat
❑ No
� i �� I
If owned with someone other than spouse, indicate with whom.
city, state, ZIP
and st�eet, city, state, ZIP code)
property in
❑ Real Property ❑ Mobile Home (IC &1.1
Does applicant own property in any other If yes, what county? VJhat Taxing District? Has this tletluaion oeen reques�eo u�
county in Indiana? property for current year?0 Yes❑ N
Deducfion approved in the amount of:
20 �� 20 �_
�"'
Signature
COUNTY AUDITOR
20 �%o I 20�
�
County Auditor
20 _� I 20
�
I I We certify under lhe penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
full
�
�
Person authorized by duty executed rower oi r.norney
or by IC 6-1.1-12-.07 '
Address of
person