HomeMy WebLinkAboutMortgage_Bell (6) °7.a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
a.
FOR DEDUCTION FROM ASSESSED VALUATION I
�� State Form 43709 Department FILED
•� Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be fled in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deckpRnistioall5 �/
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is `Xe County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the C ty Aud. Gusty
where the property is located during the twelve(12)months before March 31 of eac n is sought.
See reverse side for additional instructions and qualifications. G I BS O N COUNTY AUDITOR
lira miner or contract b er- ee rests bon reverse side)
Le a1 � “
Tax' istrict Key number/legal d ption Record number Page number
Aunta,bw a/o-I I- la- ( c3-0 00.154-oa8 J 3 Lill /
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current yearn date of application legal or equitable owner?
0 ❑ Yes ❑ No
It 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:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller S
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 street,city,state,and ZIP code)_
Doej5.aooIi" /� C hat Taxing District? Has this deduction been requested If yes,state amount of deduction
olh, 1 h- (� on property for
in Ir �}.{.rrl/'A"rl� current year? ❑Yes ❑No
Ape _ balance on the person's mortgage or contract indebtedness that is recorded in the county
recoi /�„ ,,,_� , o W =corded in the county recorder's office)that is the basis for the deduction.
/ IUJ�l.�"' COUNTY AUDITOR
Dedd 13-- 41 I I I
2 zU 20 20 20 20 20
Signatur f aunty Auditor / County Date(month,day,year)
1/We certify under the penalty of perjury Nat 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.
Signatu`�ne0/7 e e) Date(month,day,year)
Full ident address of apppllii/iccant(number and scree,city,state,and ZIP code)
I /90/ .CEY.STOA-1e /wive— f ',c,ctTos/ /&v 47677
Person authorized by duly executed Power of Attorney or by 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 S10,000.