HomeMy WebLinkAboutMortgage_Smith (32),��T•�EO STATEMENT OF MORTGAGE OR CONTRACT Filin fee $1.00
s ` INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
'. ; County Township Year
•.,�,f VALUATION State Fo�m 43709 (1-90) Prescribed by the
- State Board of Tax Commissioners
� �
� File Mark
Instructions for filing: ��� � �
To be filed in person or by mail with the County Auditor of the county e e
property is located during the 12 months before May 11 of the year the u
is to be effective. See reverse for additional instructions and qualifications.00T 12 20��
Applicant (O or-c ntract er - e resNi ti ns on reverse)
� � GIBSON COUNTY AUDITOR
Taxin District Key Number/Legal Description Record No. . �
f- �� -�/ 7`" 7 Page No. �
Assessed value of real property as Mortgage/Contraci Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of March 1, current y�ar. equitable owner? ❑ yes �� no
OOQ�.
If no, what is his/her exact share or interest? If owned with someone other than spouse,
indicate with whom. .
If name on record is different than that of applicant, indicate below:
'�me of mortgagee or contract seller
CFiI�'�ii
Address of mortgagee or contract seller
� .,Y�
Name of-Assignee or other owner or holder of Mortgage.
Address of Assignee � •
Does applicant own real property If yes, what county? What Taxing District? Has this deduction been
in any other county in Indiana? requested on property for current
year? O yes O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19 D� ��t2.3 �Y � C� LS- o200'a 19 DE 19 D�
`-is-oi �9 � S� �
Signature ��� D _ Secretary of Board of Review Date
� P
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
nts waslwere a resident of Indiana and owner of the aforementioned property on March 1, 19
„�gnature (owners full name) Person authorized by duly executed Power of Attorney or
by IC 6-1.1-12-.07).
ull Resident Address of Aplicant Address ot Authorized Person
7