HomeMy WebLinkAboutMortgage_Selfe STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
�� ; FOR DEDUCTION FROM ASSESSED VALUATION _-
° £• State Fenn 43709(R71/6-09)
Prescribed by Department of Local Government Firw¢e
Mk INSTRUCTIONS: li , v' '!�',a�ter
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought (�A County u ' r�
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months rL` iIHVCo15r(;/
before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(ovror mtractb r-see marcgonsm- me e) }��(!��/�!�
1 `` 0 V • GIBSON COUNTY AUDITOR
Q(�Y,ey number/agar descrip:• Record ben Page number
, - �a-� 2 - l + I - on . 4'18 -Dad a assp
Assessed value of real popery as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the
Marts 1,parent year March 1, date of application legal or equitable owner?
1 ❑ Yes ❑ No
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 belay. Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile F)orne QC 61.1-7)
Name of mortgagee or contract seller /\
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sheet cil) st�ate.and ZIP ode) (�
Does applicant own property in any other `-PARLES �rt 2 Has this deduction been requested on property .
county in Indiana? ❑ Yes for anent year? ❑ Yes ❑ No
13-x.551
Deduction approved in the amount of:
20 20 -- ) 20 20
Signabre of County Auditor County Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owners htf name) Date(month,day,year)
Full resident address of applicant(number and street dr);state,and ZIP code)
Person authorized by duty exeajed Power of Attorney or by IC 6.1.1-12-0.7 Date(month,day,year).
Address of authorized person (number and street,dry,state,and ZIP code)