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HomeMy WebLinkAboutMortgage_Jennings (2) 5STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township Year ,°• FOR DEDUCTION FROM ASSESSED VALUATION State Form 43709(R12/6-14) Prescribed by Department of Local Government Finance INSTRUCTIONS:d in person TL ED be filed in person or by mail. � rm fit Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. AAAAAA I� Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑ County Auditor located on or before January 5 of the immediately succeeding calendar year. MAY cpc*Y5Recorder 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county U��JJ where the property is located during the twelve(12)months before March 31 of each year the deduction is sought. See reverse side f: <ditional instruction�s¢�}}and alifications. d Applicant(owner.,] -c buyer-s;-restri ns o verse side) � `'1^�— I /VIJT GIBSON COUNTY AUDITOR Taxing District icey numb / al description Record number Pa a number G - Ib-aoo - oo4. � .oa'� © I X939 Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract in ebtedness unpaid as of Is the applicant the sole March 1,current year March 1,current year date of application legal or equitable owner? O ❑ 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 /t xr 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, la-t3-o Drawer NO *GA Soo Does applicant own property in any If yes,what c ,� been requested If yes,state amount of deduction other county 3,00 1 — { 1 ❑No in Indiana? ❑Yes ❑No 4 c� '}� )Yes A person is not entitled to this deduction unles Card NO. ..0.\-&3 'tract indebtedness that is recorded in the county recorder's office(including any home equity lir. 'at is the basis for the deduction. COUNTY AUDITOR Deduction approved in the amount of: 20 20 20 20 20 20 20 Signature of County Auditor 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 I contract buyer of the aforementioned property on date application is filed. Si. ure(owner's I '1 name) • Date(month,day,year) Il recd t pdd440,•dicantt itr i nd scree(city, Val ZIP cede) n 7670 Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 _`\/_V_i 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.