HomeMy WebLinkAboutMortgage_Hermani i �� STATEMENT OF MORTGAGE OR CONTRACT INDEEiTEDNESS
��J FOR DEDUCTION FROM ASSESSED VALUATION Covn Township Year
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i + S�ate Form 43709 (R6 / 5-06) . . . . ' .
� Presoibed by Department of Loral Gwemment Finance �
INSTRUCTIONS: MAY 3 O Z00% File Mark
To be (iled in pe�son or 6y mail with the County Audito� of the county whe�e the property is located. � � '
Filing Dates: 7) Real Property: Dunng the 12 months before �une Il o/ the yea� the deduction islo be eff�tive. , :
2) Mobile Nomes assessed under IC 6-1.1-7: Between January 15 and March 2 oY�{��fr'�e��Eductlon is to be effective.
See reverse side lor additional instructions and quali(ications. GIBSON COUNTY AUDITOR
Applicant (owne r contract buyer - s
Tauin Distrid
V'v✓ 11l{J��
Assessed value of real prope as of
March 1, wrrent year
If no, whal is his / her exad share
on reverse side)
Key number / legal description ( Record number � n
i_ ��
-3a - oo - o00 . ys - _ �ye numoer r /� ^ -�
J ' / o+�
Mortgage / Contrad indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 1, wrrent year owne(? ❑ Yes ❑ No
6
If owned with someone other than spouse, indicate with whom.
If name on record is different than lhat of applicant, in
�me of mortgagee or contrad seller
` r%�-��
Address of mortgagee or contract seller number and
Name of assignee or other owner or holder of mortgage
of assignee (numberand st2et, city, state, ZIP
Dces applicant rnvn property in any other I If yes, what county?
county in InAiana?
Deduction approred in the amounl of:
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Signature
20
state,
What Taxing Distrid?
COUNTY AUDITOR
20 20 20
P
County Auditor
sthe property
❑ Real Pmpe�iy ❑ Mobile Home (IC 61.1-�
Has this deduction been requested on
property for current yeaR� Yes❑ No
20
Dafe
20
certify under the penalty of perjury thai the above and foregoing information is true and correct and that the applicants was / were
lent of Indiana and owner of the aforemenlioned propeRy on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07 �
� n Address of authorized person
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