HomeMy WebLinkAboutMortgage_Sandeferrt��' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
, �, N�� � Slate Form 43709 (R4 / 10-01) �.--y � ':,; �
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Prescribed by Depariment ot Lccsl Gc•:emment Finarice FL-? �
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INSTRUCTIONS: .JU� �F��le���
To be filed in person or by mail with the County Auditor o( the county where the property is located. ^ � /J ^��
Filing Dates: 1) Real Property: During the 12 months before May 11 of the year the deduction is to be eflective. �+
2) Mobile Homes assessed �nder IC 6-1.1-7: Behveen January 15 and March 31 0/ the_year tbe�deduchon is to�tie•eNecfive.
See reverse side for additional instructions and qualifications.
�� GIBSO�d COUN1 Y i:J�� •���
Applicant (owner or contract buyer- see restricG'ons on reverse side)
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Tauing Distrid Key number / legal description ecord number !,� �_
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Page number
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Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the so e legal or equitable
March 1, wrrent year March 1, current year owneR es ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is diBerent than lhat of applicant, indicate below: Is the property in question:
�Real Pmperty ❑ Mobile Home (IC Cr1.1-�
�e of mortgagee or contrad s�tie�
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Address of mortgagee or contrad selier (number and street, city, state, ZIP
Name of assignee or other owner or holder oi mortgage
Address of assignee (number and st�eet, city, state, ZIP code)
Does applipnl own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for wrrent yeaR� Yes❑ No
COUNTY AUDITOR � ' p ��� 5 � �
DeducGon approved in the amounl of:
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Signature County Auditor Date
We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and lhat the applicants was / were
resident of Indiana and owner of the aforemenlioned propeRy on March 1, 20
Sig lure (owners full name) Person authorized by duly executed Power of Attomey
�� or by IC 57.1-12-.07
Full resident address of applicant . Address of authorized person
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