HomeMy WebLinkAboutMortgage_Wiggins�
� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
� �� I State Fortn a3709 (RS / 4-03) � �1 �
� PrescnbeE by Department ot Loral Govemment Financa �
INSTRUCTIONS: MAR 1 ��Q���
To be filed in person or by mail with the County Auditor o7 the county whe�e the propeRy is located.
Filing Dates: 1) Real Property: During fhe 72 montbs be)ore May 11 0/ the year the deduction is to be e,fj�fjue. �Q��-g
2) Mo6ile Homes assessed under IC 6-7.7-7: Between January 15 and March 2 of the year the d'eductiof✓is to be effective.
GIBSON COUNTY AUDITOR
See reverse side Ior additional instructions and qualifications.
Applicant (ownerorcontract buyqr-see
Assessed value of real property as of
March 1, current year
If no, what is his / her exac[ share of intei
If name on record is different than that of
side)
Key number / legal description
�.�-i�._o7 -io3-000.3ba
Mortgage ! Conlradir
March 1, current year
Page number
unpaid as of Is the appticant the sole legal or equitable
ownef? ❑ Yes ❑ No
>t-' ' I If owned with someone other than spouse, indicate with whom.
OG �'� 'f� Is the property in question:
Dra�ver 1�' .
.............��
❑ Real Property ❑ Mobile Home (IC 61.1-�
.me of mortgagee or contrad seller
/� Card N . .....................
Address of mortgagee or contrad seller ^'-+ati��/ O'("�fJ //�•�
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 District?
county in Indiana?
Deduction approved in the amounl of:
20
Signalure
COUNTY AUDITOR
20 Q� I 20 �`L I 20 I 20
i �
Couniy Auditor
Has this deduclion been requested on
property for wrrent yeaR�] Yes� No
20
20
We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicanls was / were
�esident of Indiana and owner o( the aforementioned property on March 1, 20
Iull name)
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
of authorized person