HomeMy WebLinkAboutMortgage_TurpinSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
� / State Fortn 43709 (RS / 4-03)
� I PfescriDetl Dy DepaM.ertt of Local Govemment Finarrce
�NSrRUCnoNS: �AN 1 7�@l�`�`
To be filed in person or by mail wfth the County Auditor of the county wAe2 the propeRy is located.
Filing Dates: 1) Real PropeRy: Dunng the 12 mon[hs before May 11 of the year the deduction is to be e/fective. '�""
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year�R.�ded�xery}s to be eHective.
See �everse side (oradditional instructions and qualifications� � G�BSON COUNTY AUDITOR
_ A . h
Applicant (owne�
Assessed value of re:
March t, curtent year
no,
see
Key number /
side)
number
/� � �_O/� [G}j 2 � Page number � �_
C/ � T [l �J
property as of Mortgage / Contrad indebtedness unpaid as of Is lhe applipnt lhe sole legal or equitable
March 1, current year owneR ❑ Yes ❑ No
57�oc�
/ her exacl share of interesl?
If name on record is different ihan that
of moRgagee or contred seller
Address of mortgagee or contract seller
Si
If owned with someone other than spouse, indicate with whom.
indicate below:
and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and stieef,
Does applicant own property in any
county in Indiana?
Deduction approved in the amount of:
20
Signature
r� �
state, ZIP code)
If yes, what county? � What Taxing District?
COUNTY AUDITOR
20 0� 20 20
/ County Auditor
Is the property in questian:
❑ Real Pm�erty ❑ Modle Home pC 61.1-�
Has lhis deduction been requested on
property for current year?� Yes❑ No
�
Date
20
We certify under the penalty of peryury that the above and foregoing information is true and corred and thal lhe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person