HomeMy WebLinkAboutMortgage_Dickson STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
f �i FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
State Form 43709(RS/4-03) -
® Prescribed by Department of Local Government Finance - , � ! is
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INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor of the county where the property is located.
JAN N 1 2 2006
Filing Dates: 1) Real Property:During the 12 months before May 11 of the year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7:Between January 15 and March 2 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications. % a� leg
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C./L - LC) — 06 'CI oO - CO a O at, GIBBON COUNTY AUDITOR
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Taxing District , Key number/legal description Record number
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1,current year owner? ❑Yes ❑ No
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If no,what is his I 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:
❑Real Property ❑Mobile Home(IC 6-1.1-7)
®me of mortgagee or contract seller
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Address of mortgagee or contract seller(number and street, city, st ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street, 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 current year?❑Yes No
Drawer NO........ —
Card NO .c
Deduction approved in the amount of: °?
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20 01 zo 61 20 09 __ _ 20
Q Q P
1
Signature County Auditor Date
We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was/were
resident of Indiana and ow.-r-o aforementioned property on March 1,20 .
SigDeyur wners / Person authorized by duly executed Power of Attorney
l7" or by IC 6-1.1-12-.07
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Ful arnt address of applicant Address of authorized person
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