HomeMy WebLinkAboutMortgage_Bartoni a �� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
``s��; FOR DEDUCTION FROM ASSESSED VALUATION
'v__ .j Stale Fortn 43709 (R6 / 5-06) '
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� � Presaibed by Department of Lopl Govemment Finance
INSTRUCTIONS:
Coun Township Year
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To be filed in person o� by mail with the County Audrto� of the county where the property is located. Z��$
Filing Dates: 1) Real Property: During the 12 months before June Il of the year fhe deduction is to be elfective:—y�,
2) Mobile Homes assessed under IC 6-1.1-7_ Between January 15 and March 2 of the year the dedGEfiB�s�,f�a eflective.
See reverse side fo� additional instiuctions and qualifications. GIBSON COUNTY q DITOR
Applicant (owner or contract buyer- see restrictions on reverse side)
Taxing Distrid Key number / legal description Record number O
'1 O`� ' �� ��
Page number / / �
b- - y o. �P
Assessed value of real properly as of Mortgage / Contrad indebtedness unpaid as of Is the applicant t e sole legal or equitable
March 1, curtent year March 1, current year owneR s❑ 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 than that of applicant, indicate below: Is the property in question:
eal Property ❑ Mobile Home (IC 61.1-�
e of mortgagee or contract seller - _
L a�r��- ���� s2/ - -- —
Address of mortgagee or conVad seller (number and street, city, state, ZIP [� � lw � `� �l�}/'�=—� � W
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Name of assignee or other owner or holder of mortgage D�� ji1G" '" '�.�
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Address of assignee (number and st2et, city, s(ate, ZIP code) _
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for curtent yeaR � Yes❑ No
COUNTY AUDITOR
Deduction approved in the amounl of:
20 �� 20 � 20 O 20 20 20 20
P P �
Signature County Auditor Date
'' We certify under the penalty of perjury lhat the above and foregoing information is true and corred and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20 �
Signature (qwners��i � Person authorized by duly executed Power of Attomey
��� or by �C 6-1.1-12-.07
F II sident address of applican Address of authorized person
�Pa v r a�. �.�5 � �fi �,�.