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HomeMy WebLinkAboutMortgage_Young (7) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year • t. _ FOR DEDUCTION FROM ASSESSED VALUATION • ,. State Form 43709(R12/6-14) k,a-. Prescribed by Department of Local Government Finance g g INSTRUCTIONS: F q q E D File Maw led wt To be filed in person or by mail. I. JXLJ. Filing Oates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. Must be filed or postmarked with the County Auditor or County Recorder of N cyu((ty w,¢( he property is �ounty Auditor located on or before January 5 of the immediately succeeding calendar yeaP/l�l D LU IJ ❑ County Recorder 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county where the properly is located during the twelve(12)months before March 31 o ach yea the coon is sought. See reverse side for a ition I instructions and qualific. Applicant(owner or tmEtb se resficti son reve ; GIBSON COUNTY AUDITOR Tax',• I's ct Key number/I description Record number Page number • (` aG- / (h/ dQ'- 0 3V-096 2_.o/(I 5ct3/ Assessed value of real property as of Mortgage/Co ract indebtedness unpa as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole March 1,current year March 1,cr year date of application legal or equitable owner? j410000 ❑ 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: Is the property in question:Annually Assessed ❑ Real Property ❑ Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller Address of mortgagee or contract seller(number and street,c),state,and ZIP code) Name of assignee or other owner or holder of mortaano- - Addressd /'')Ll /�/'�(J��/7�'l J•••••• I What Taxing District? Has this deduction been requested If yes,state amount of deduction L O•,Y.• • on property for Dowel current year? ❑Yes 0 N A �3 :a balance on the person's mortgage or contract indebtedness that is recorded in the county re, _ .•••.•••• :recorded in the county recorder's office)that is the basis for the deduction. _ Cal.d I' COUNTY AUDITOR De, .er 20 20 f�y1G^J/�p 20 20 20 20 20 Signaler of >n u 'tor �- k`' '�" `�~ County / L Date(mo yea I e 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. Si note ow ?s full name Date(month,day,year) F II resident address of a lic (((nuumb`/e�r"a�'ndd street,city,state.and ZIP code) Person I2-I authorized executed fr Powerot At y ( by IC 6-1.1-12-0.7©� 4µ0 Cr 4c �7 o&D�oonth,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$10,000.