HomeMy WebLinkAboutMortgage_McClellan (7)RI
STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
' ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
` J State Form 43709 (R4 / 10-07)
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Presqibe0 by Depanment of Local Govemment Finance
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INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor of the county where the property is located. �"�AY Q$ 2��3
Filing Dates: 1) Real Property: During the 12 monfhs before May 11 of the year the deduction is to be eflective.
2) Mo6ile Homes assessed under IC Sl.l-7: Behveen January 15 and March 31 of the�ar the deductio�is to b ef/ tive.
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See reverse side /or additional instructions and qualifications. �)�����
� GIBSOtd COU?:TY .4UDITOR
on
Key number / legal description � Record
l o — •
� oi9_ �9a � Page number n
y
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owneR ❑•Yes ❑ No
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If no, what is his / her exact
If name on record is different than that of applicant, indicate below:
of moKgagee or conVad seller
Address of mortgagee or contrad seller (number and street,
assignee or other owner or holder of mortgage
Address of assignee (num6er and st2et, city, state, ZIP code)
Does applipnt own property in any other I If yes, what county?
.
munty in Indiana?
20
Signature
approved in the amount of:
20 Q�
If owned with someone other than spouse, indicate with whom.
ZIP
What
couNrrau�n
20 �? 20 �
o°
County Audilor
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s the property
❑ Real Proper
❑ Mobile Hane pC 6-1.
r - --
c`��- `I1r�r'. o� ��..
DrawerNO.....�a••• auestedon
(�� r O 7 Yes ❑ No
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CardNO . .....................
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20 �� 20 �
P P
Date
/ We certify under the penalty of perjury that the above and foregoing infortnation is lrue and corred and that the applicants was / were
i resident of Indiana and owner of the aforementioned property on March 1, 20
ature (owners (ull n�am�e)J
//�C�/y� i�'K ,
resident address of appli
�is�.�
Person authorized by duly execuled Power of Attomey
or by IC 6-1.1-12-.07
of authorized person