HomeMy WebLinkAboutMortgage_Lohe�°o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
° "s FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
S � J Slate Form 43709 (R4 ! 70.07) ( p , �
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� Prescribed by Depariment of Loral Govemmen� Finance B^ i
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wsrRUCnoNS: ApR �i��002
To 6e filed in person or by mail with the County Auditor of the counly whe�e the property is located.
Filing Dates: 1) Real Property: During the 12 months 6e)oie May 11 of the yea� the deduction is to b�Ifectiv .
2J Mo6ile Homes assessed unde� IC 6-1.1-7: Behveen January 15 and March 31 of the ,fs�{g�8@7iective.
See reverse side for additional inst�uctions and quali�cations. GIBSON CO
Applicant (ovmer or contract buyer se restriction on rev se side) �
Taxing Distrid Key number al de cr tion ecord number D�
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Assessed value of real property as of MoAgage / Contracl indebtedness unpaid as of Is the applicant lhe sole legal or equitable
March 1, current year March 1, curren year owner? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned wilh someone other than spouse, indicate with whom.
If name on record is different than that of applicanl, indicate below: Is the property in question:
❑ Reai Property ❑ Mobile Home (IC 61.1-�
�me of mortgagee or contract seller
Address ot mortgagee or contrad seller (number and stieet, city, state, ZIP�
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Name of assignee or other owner or holder of mortgage
Address of assignee (num6erand st�eet, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? property for wnent year? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
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Sign ure 9 County Audilor Date
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I/ We certify under the penalty of perjury that the above and foregoing informalion is true and correcl and that fhe applicants was / were
�xsident of Indiana and owner of the aforementioned property on March 1, 20
ature (owne/s (ull name Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
ull resident address icant Address of authorized person
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