HomeMy WebLinkAboutMortgage_Schultheis (3)/e�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�i'�; FOR DEDUCTION FROM ASSESSED VALUATION
�y • Slate Form 43709 (R6 / SO6)
� PresQibed by Depanment oi Laal Gwemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the Couniy Auditor of the county where the property is located. �r C"o G 9 2���
Filing Dates: 1) Real Property: During the 12 months 6efo2 ,lune I1 0l the year the deduction is to be e//BCYrI�.
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 o/the year the deducGon is to be eflective.
See reverse side (or additional insWctions and qual�cations. �� 'e �
GIBSON COUNTY AUDITOR
Applicant (owner
see resMct�,ins on j�ver�e side)
Key number / legal description � Record number
l//���� oZ�o –�c� �� a-03 -00/. � P�(j�er �J 7J/
7
Assessed value oi real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year March 1, cunent year owneR ❑ Yes ❑ No
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If no, what is his / her exad share of interest? If owned with someone other lhan spouse, indicate with whom.
name on record is difierent than that of applicant, indicate below:
of mortgagee or contrad seiler
of mortgagee or conVad seller (number and street, cify, state, ZIP
or other owner or holder of mortgage
of assignee (numberand street, city, state, ZIP
Does applicant own property in any other If yes, what county?
county in Indiana? -
Deduction approved in the amoi
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Signature
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Taxing Distrid?
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Dra��er i _
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Card • • "
❑ Real Property ❑ Mobile Home (IC 61.
Has this dedudion been requesled on
property for wrrent year? � Yes ❑ No
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certiy under the penalty of per�ury that the above and foregoing infortnation is true and corred and thal lhe applicants was / were
lenl of Indiana and owner of the aforementioned property on March 1, 20
Full resident address of
05
Person authorized by duly executed
or by IC 6-1.1-12-.07
7 i 7(� �Address of authorized person