HomeMy WebLinkAboutMortgage_Wallace (16)d�rt•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'�'-° �: FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
S J State Form 43709 (R4 / 10.01)
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��� Prescribe0 by Department of Local Govemment Finance
INSTRUCTIONS: rIQK 2F(iJe�
To 6e filed in person or by mail with the County Auditor ol the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months belore May 11 olthe year the deduction is t e ef/ecti�
2J Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 of t,thg, �,du is t e ective.
See reverse side (oradditional instructions and quali�cations_ GIBSON COU !� qUDi70R
Applicant (own � o� tract buyer- see re ' tio on ve e side)
Taxing District Key number / �egal description Record number ��
�/ jJ ,„�� Q�O 9 � �� Page number S� S�
/ L.!/ I �
Assessed value of real property as of Mortgage / ContraG indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 1, current year March 1, current year ownef? ❑ Yes ❑ No
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if no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different lhan lhat of appiicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home pC Crt.t-�
�e of mortgagee or contrect seller �
Address of mortgagee or contrad seller (number and street, city, state, ZIP
;� „�. l��- 7
Name of assignee or other owner or holder of mortgage ° "
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for current year? ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
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Sig ature County Auditor Date
�We certify under lhe penalty of perjury that the above and foregoing information is lrue and correct and that the applicants was / were
zsidenl of Indiana and owner of the aforemenlioned property on March 1, 20
Si n (owners full name) Person authorized by duty executed Power oT Attomey
or by IC 6-1.1-12-.07
Full resident address o applicant Address of aulhorized person
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