HomeMy WebLinkAboutMortgage_Woolsey�e� �?,� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
's' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
J State Fortn 43709 (R6 / 5461
� Aesaibed by Depanment of Loml GovemmeM Finance
wsrRUCnorvs: �AN 2�e�
To 6e filed in person o� by mail with the County Auditor o1 the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months beloie ,lune 11 of the year lhe deduction is to be elf /�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the yea� ��W��b be eHective.
See reverse side lor additional instructions and qual�catrons. GIBSON COUNTY AUDITOH
Taxing
�., � -, a -�. , - f � � -
Assessed value of real property as of
March t, wrrent year
If no, what is his / her exad
ti�ns on revgrse side)
Key num�ber / lega e
��d�-C
MoAgage / Contract ii
March 1, currenl year
name on record is different Ihan that of applicant,
of mortgagee or contraC seller �_
Address of mortgagee or conUad seller (number and
Name of assignee or other awner or holder of mortgage
Address of assignee (number and st2ef, city, state, ZIP
Record number
Page number
unpaid as of Is the applipnt the sole legal or equitable
owneR ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
aty, state, ZIP
Does applipnt own property in any other Ii yes, what county?
county in Indiana?
Deduction approved in the amounl of:
zo P I zo �
Signature
s the property
❑ Real Property ❑ Mobile Home pC 61.1-�
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7� ��
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What Taxir vv . , }41 .� on
� �.r u.....
c:,� a �o. ... �. �� No
COUNTY AUDITOR
2� 2� 20
County Audilor
�
Date
20
certify under the penalty of perjury lhat the above and foregoing information is true and correct and that the applicants was / were
lent 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
full resiOEn[ atltlress of applicant (/ Address of authorized person
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