HomeMy WebLinkAboutMortgage_Neasee�" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-- :• FOR DEDUCTION FROM ASSESSED VALUATION
S � State Form 43709 (R4 / 10-07)
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� PrescribeA by Department of Local Govemment Finance
INSTRUCTIONS:
'fo be filed in person or by mail with the County Auditor o/ the county wheie the property is located.
Filing Dates: 1) Real Property: During the 12 months be%2 May 11 of the year the deduction is to be effect�� N Z I 20�2
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 0/ the year t�tion i to be eHective.
See 2verse side for additional instructions and qualifrcations.
�O GIBSON COU�TY FUDITOR 1
Applicant (ownerorcontract buyer- see restnctions o/n reverse side)
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Taxing District Ke mber / legal description Record number �
P � Page number
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Assessed value of real properry as of Mortgage / Contract indebtedness unpaid as of Is the applican t�sole egal or equitable
March 1, current year March 1, currenl year owneR es ❑ No
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If no, what is his / her exad share of interesl? If owned with someone olher than spouse, indicate with whom.
If name on record is diNerent Ihan that of applicant, indicate below: Is the property in question:
eal PropeAy ❑ Mobile Home (IC Cr1.1-�
fd, me of mortgagee or contrad seiler
Address of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Taxing District? Has this dedudion been requested on
county in Indiana? property for current year? � Yes � No
COUNTY AUDITOR
Dedudion approved in lhe amount of:
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Signature County Auditor Date
I/ We certify under lhe penalty of perjury lhat the above and foregoing informalion is true and corred and lhat ihe applicants was ! were
�esident of Indiana and owner of the aforementioned property on March 1, 20 .
natur rs full na Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Ful re dent address of appliqnt Address of authorized person
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