HomeMy WebLinkAboutMortgage_Sprinkle•T•T,o STATEMENT OF MORTGAGE
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a�_ =y ; INDEBTEDNESS FOR DEDUGTION
°`-.�' VALUATION State Form 43709 (1-90
�� State Board of Tax Commissioners
FOFM 5
OR CONTRACT Filin fee $1.00
FROM ASSESSED County .�T.ownship Year
) Prescribed by the �
Instructions for filing: - , AUG 2 9 2�d� Mark
To be filed in person or by mail with the County Auditor of the county where th
property is located during the 12 months before May 11 of the year the deductio
is to be effective. See reverse for additional instructions and qualifications. GIBSON COUNTY AuDITOR
Applicant (O r or contr buyer see restric ion on reverse)
Taxin District . Key NumbedLegal Description Record No. �O � ,
� � (Q� U Z�� Page No. S
Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of arch 1, current year. equitabie owner? O yes .O no •
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: , - -� �. _
���ne of mortgagee or contract seller ,
'' , . . • ..
Add�ess of mortgagee or contract seller " • " �
• , • ,
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 J no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
Year�_ 9��i���3 Yearvl.pe`�' Year2�.2� Year, � Yearv?l�Jr
. -bi � � P �'
Signature 20� 4'P Secretary of Board of Review Date
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the
licants was/were a resident of Indiana and owner of the aforementioned property on March 1,
ig ature (owners full name) • Person authorized by duly executed Power of Attorney or
, . �, by IC 6-1.1-12-.07).
Ful Resident Address of A licani Address of Authorized Person
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