HomeMy WebLinkAboutMortgage_Johnson ., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
;�s_— ' FOR DEDUCTION FROM ASSESSED VALUATION
\':� '' State Form 43709(R12/6-14)
\ Prescribed by Department of Local Government Finance .
INSTRUCTIONS: e
To be filed in person or by mail.
r ` th:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is so t.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is 1 ❑c1 County Auditor
1
located on or before January 5 of the immediately succeeding calendar year. APR .0 0119 County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is
See reverse side for additional instructions and qualifications.
Appli nt vner or conVact b see restrictions on reverse side)
�[(L GIBSON COUNTY AUDITOR
Taxing District Key n ber/legal description Record nurt),Uer Page nib
to-t3 - A5-Aoo - 000 .9 8 -00 .6 ! ll7/
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,current year March 1,current year date of application legal or equitable owner?
1 3 850 ❑ 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 below: I Is the property in question:Annually Acossed
__ --- . .-- ;sect
.n QC IC 6-1.1-7)
Name of mortgagee or contract seller � � 11!1111 or Q_FAS Address of mortgagee or contract seller(number and street,city,state,and ,V. /Y1-- !\
Name of assignee or other owner or holder of mortgage `r f ^ (� r ]
Address of assignee(number and street,city,state,and ZIP code) `�O l.JV q
Does applicant own property in any If yes,what county? What 1 /h O 15_ 11180 J ion
other county c9015_
l/.i/ V
in Indiana? ❑Yes ❑No o/
A person is not entitled to this deduction unless the person has a ba, 4I ®/ aunty
recorder's office(including any home equity line of credit that is reco 'Q 13 5/S SO'
Deduction approved in the amountof: ��YY JJJ 1VV_800_322_3391
20- 20 20 Insurance and Risk Management for Local Govemments
I I
Signalurgnatur of County Date(month,day,year)
I/We certify under the penalty of of per1�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(((oowwner'ss fuuyniii e) Date(month,day,year)
Full resident addles• , h pli nt(number and street,city,state,and ZIP code)
.a27,2L ey 57 44/44 0/ (///v- /tree&o
Person authorized by duly executed Power of Attorney or y IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 810,000.