HomeMy WebLinkAboutMortgage_Rexing (9) .: STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
'k r State Form 43709(R12/6-14)
. Prescribed by Department of Local Government Finance F I L
ar
INSTRUCTIONS:
Fil
To be filed 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 deduction is sought. 11II//r� 1 ,,qq{�1
Must be filed or postmarked with the County Auditor or County Recorder of the county where the propertyMAY 1 I Etfi iSounty 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 County Auditor of the cou r
where the property is located during the twelve(12)months before March 31 of each year the deduction is ••#f;y ;emit
See reverse side for additional instructions and qualifications GIBBON COl1NTY AUDITOR
App'cant(ov or contra r-see restnction)ve sr e) e
Q
Tax g •strict. Key ber/legal descn r n ' Record number Pa e number
.� _:
• . , . , -�°7- . oo- �n_a 1r - - D- 0 cPO/e
-.value of real property.s of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appfican the sole
Mardi 1,current year March 1,current year date of application r/J ,{ /l legal or equitable owner?
/�• / U e`-' ❑ 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 th property in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller /'s 1 , 7
Address of mortgagee or contract seller(number and/1.t,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage //1
Address of assignee(number and street,city,state,and ZIP code)
�l V 11 a— 3- //
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for ,--, �3 ga
in Indiana? ❑Yes ❑No _ current year? ❑ ❑Yes No
A pers a()l S — S 3-1 balance on the person's mortgage or contract indebtedness that is recorded in the county
record. 1 =corded in the county recorder's office)that is the basis for the deduction.
Cn°-\��.2.\J C'�I.I �x t'^11S*dd� COUNTY AUDITOR
Deduc \Lk-CAA* J�o\C
Drawer NO
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2 —3—et— IS y6 1�� tI 20 20 20 20
Card NO. t• Ob . OU
Signati 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 aforementione property on date application is filed.
Signature( ame) A// Date(month,day,year)
Fu I?esident address of applicant(number and street,city,state,and ZIP code)
r, &a q 6, 9
Person'-uthorized by duly executed Power of Attomey or by IC 6-1.• 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$10,000.