HomeMy WebLinkAboutMortgage_Shade (3)STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
t I StaU Fwm 43709 (RS / 4-03) .
� P�escriEed bY Dapert+nent of Local Govemment Finance
INSTRUCTIONS:
To be filed in person or 6y mail witA the CountyAUditor of the counry where the propeRy is located.
Filing Dafes: 1) Real Property: During lhe 12 months be%re May 11 of the year the deduction is to 6e effectiv�e.E P 1 5 Z��6
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0( the year the deduction is to be effective.
See reverse side Ior additional instructions and ualifications. ,Q
9 '�%fa�
GIBSON COUNTY AUDITOR
Applicant
Tauing District
i � (3-t •
buyer-
Assessed value of real property as of
March 1, wrrent year
side)
Key number / legal desuiption Record number
o?G,d �s-�c� 000•�.�-aa6
,(% � I _ - OO Page number
V
Mortgage / Contrad indebtedness unpaid as of Is the applii
March 1, curcent year owneR
I the sole legal or equitable
❑ Yes ❑ No
I( no, what is his / her exaa share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is difterent than that of applicant, indicate below: Is the property in question:
� � Real Property ❑ Mobile Hane pC 61.
�me of mortgagee or conUact selier � �
Address of mortgagee or conVad seller (number and stieet, city, state, ZIP
Name of assignee or other owner or holder of morigage
Address of assignee (number and street, city, state, ZIP code)
Does applipnt own property in any other If yes, what county?
county in Indiana?
Deduction approved in lhe amount ot:
20 �7
Signature
� ���
What Taxing Distrid?
COUNTY AUDITOR
20� 20 20
�
County Audi�or
Has lhis dedudion been requested on
property for current year? � Yes ❑ No
20
Date
�
ify under the penalty of perjury that the above and foregoing informalion is true and corred and that lhe applicants was / were
of Indiana and owner of the aforementioned property on March 1, 20
of
L�
Person authorized by duly
or by IC 6-1.1-12-.07
of authorized person
Attomey