HomeMy WebLinkAboutMortgage_Davis (9) �v STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
rb; . FOR DEDUCTION FROM ASSESSED VALUATION
•" i` State Form 43709(R12/6-14) t II ..'
'' ', Prescribed by Department of Local Government Finance — i W.
INSTRUCTIONS:
To be tiled in person or by mail. filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. JUN 9 0
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. / , E .•my Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of th- i . -
where the property is located during the twelve(12)months before March 31 of each year the deduction• �-.h: G e .....
See reverse side for additional instructions and•ualifications. GIBSONCa NTY AUDITOR
AppG nt( ner or)71 buyer-3ee restriction verse side)
•
Taxing D' 'ct I / Key number/legal description Record number Page num r
r. 6, - /0 -016- U- add. ,3,3/_D02/ goer /1
value of r. property Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March ,current y-:' March 1,current year date of application legal or equitable owner?
/� ri A� ❑ 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: `IIss the property in question:Annually Assessed
m Real Property (L1 Annually Assessed
/ ` Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Gel/C/CEnv �n '.5
Address of mortgagee or contract seller(number and street,city,state,and ZIP c e)
Name of assignee or other owner or holder of mortgage
OZ —o?/. / aSAe.,
Address of assignee(number and street,city,state,and ZIP code)
,j .� L41
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been req ested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes ❑No current year? ❑Yes ❑No
A in has a balance on the person's mortgage or contract indebtedness that is recorded in the county
re V13/ � � �, , ) that is recorded in the county recorder's office)that is the basis for the deduction.
W COUNTY AUDITOR
20 20 20 20
County Date(month,day,year)
I 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 aforementioned property on date application is filed.
Signature(owner's(owyner'ssrruueee na e) Date
C/�}.//(/1�n/c' Date(month,day,year)
I Full r"si—t ed red ss oydppltc2rR(number and street, and ZIP code) r /
YOsg S. Tod J J . DCJF_�/sr//// If 76 6�
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$10,000.