HomeMy WebLinkAboutMortgage_Minnis (6)'°R�° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'*-'° `' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S�� j State Form 43709 (R4 / 10.01) � /�
� Prescribed by Department of Loral Govemment Finance
INSTRUCTIONS: MA�;ie r�R��002
To be filed in person or by mail with the County Auditor of the county wheie the property is located.
Filing Dates: 1) Real Property: During the 12 months befo2 May 11 o/the year the deduction is to be effectiv����k�����
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Marc6 31 of the y�'af ttre �tto be e ec " e.
' G�BSON CfOUNTY AUp�TO�
See reverse side (or additional instiuctions and qualifications.
Distrid
on reverse
Key number
Record number
�/Q �� l s S'� 'O � Page number
� �� O
Assessed value of real property as of MoAgage / Contrad indebtedne�y1{� d as of Is the applicant the sole legal or
March 1, cunent year March 1, current year '� �� ZS '( �, owneR ❑ Yes ❑ No
,.�12 F,c "-� �°
if no, what is his / her exact share of interesl?
If name on record is different than that of applicant,
of mortgagee or contrad seller
Address of mortgagee or contrad seller (number and street,
Name of assignee or other owner or holder of mortgage
of assignee (numberand street, city, state, ZIP
If owned with someone other than spouse, indicate with whom.
below:
state, ZIP
Does applicant own property in any other If yes, what counry? � What Taxing District?
county in Indiana?
Dedudion approved in the amount of:
�rrs�m
COUNTY AUDITOR
20�� 20 Q� 20
� �
County Auditor
Is the properiy in question:
❑ Real Properiy ❑ Mobile Home pC Fr1.t-
Has this deduction been requested on
property for current yearl Q Yes 0 No
zo ��
Date
��
certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
Ient of Indiana and owner of the aforementioned property on March 1, 20
full
Person authorized by duly executed Power of Attomey
_ or by IC 6-1.1-12-.07
address of applicant°, "' �Address of authorized person
0