HomeMy WebLinkAboutMortgage_Price��"� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
`\-. � FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
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� � • Siate Form 43709 (R6 / 5-06)
Presvibetl by Departmenl of Local Gwemment Finance
INSTRUCTIONS: � � fl �ile�Aarp
To be liled in pe�son o� by mail wrth the CountyAuditor of the county where the p�operty is I ted. �i J F�
Filing Dates: 1) Real Prope�ty: During the 72 monihs 6efore June Il of the year the deduction is to be elfective.
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 of the�� ti� de�gn is to 6e eHective.
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See reverse side fo� additional instiuctions and qualificalions.
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Applicant (ownerorcontract b r- see restrictio s on re erse side) GIBSON COUNTY AUDITOR
Taxing District y number / legal descriplion Record number � p
d
Pa e number
G�'..w�.�u� a�-�3� -►�o-�. c��r � I a
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applipnt the sole egal or equitabie
March 1, current year Mar� current year owneR ❑ Yes ❑ No
I 1 ��
If no, what is his / her exact share of interesl? If owned with someone other than spouse, indicate wilh whom.
If name on record is different ihan ihat of applicant, indicate below: Is the property in question:
❑ Real Property p Mobile Home QC 61.1-n
e of mortgagee or conVact seller -- -
Address of 2GG � ,2 3 tate, ZIP
DC��\'PC \0 .............-/..
Name of a:
ard NO . ...... ..............
Go�,o�
Address of bp y�q �� !. ��_, ., „we�
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has lhis dedudion been requesled on
county in Indiana? property for current yeaR� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 _� 20 20 20 20 20 20
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Signature County Auditor Date
We certify under the penalty oi perjury lhat the above and foregoing information is true and corred and that the applicants was / were
�esident of Indiana and owner of the aforemenlioned property on March 1, 20
Si nature o s/ull name) — Person authorized by duly executed Power of Atlomey
or by IC 6-1.1-12-.07
Fu( re�s,iden ress of appliqnt Address of aulhorized person
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