HomeMy WebLinkAboutMortgage_Speedy (3)��
STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�j State Fwm 43709 (R5 / 4-03)
� PrescnEed by Department ol Loca� Govemment Finance � r T S'-9 I f—,
� il 1; �I � �
INSTRUCTIONS: � 1 � 11� ��e M�
To be filed in person or 6y mail with the County Auditor o! the county where the property is located. N O V �� » 20�4
Filing Dates: 1) Real Property: During the 12 months before May 1 i o/ the year the deduction is to be etfective.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0% the year th� deduction is-to be effective.
L/ `7
See reverse side (or additional instructions and quali�cations. i�����
�O GIBSON COUN i v qUG�TC3
Appli nt (o ner or contract 6uyer - see restrictions on reverse side)
V
Taxinq Distri Key n er! legal description Record number
l / ` 00'��
i � D ^ _ a� � / � _ � Page number � � � / _
y ��
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant �the� ole legal or equitable
March t, current year March 1, current year owner? L1YS'es ❑ No
�/35aC�
If no, what is his / her exacl share of inierest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different lhan that of applicanl, indicate below: Is the pr9Perty in question:
❑i�al Property ❑ Mobile Hane (IC 61.1-�
��e of mortgagee or contract seller Jc'/�
Address of mortgagee or contraIX seiler (number and street, city, state, ZIP
Name of assignee or other owner or holder oi mortgage
Address of assignee (num6erand street, city, state, ZIP code)
Does appliwnt own property in any other If yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? property for current year?�] Yes� No
- COUNTY AUDITOR
Deduction approved in the amount of:
20 D 20 FI�1 20 �_ 20 m� 20 20 20
� � �
Signature County Auditor Date
�� We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and thal lhe applicants was / were
sident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners full name) Person authorized by duly executed Power of Attomey �
or by IC 6-1.1-12-.07
Full resi addres f app nt Address of authorized person
� � , �'�/�
�