HomeMy WebLinkAboutMortgage_Hart �c STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
raL f FOR DEDUCTION FROM ASSESSED VALUATION
il State Form 43709(R12/6-14) g ��g''''111
�'\„f Prescribed by Department of Local Government Finance p ' J kI)
INSTRUCTIONS:
To be filed in person or by mail. Form filed with:
Filing Oates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. II
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is N 1 ' ounty Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the co I I ■./ ' Recorder
where the property is located during the twelve(12)months before March 31 of each year the deduction is...1-f '1
. 4:17r),Cr
See reverse side for additional instructions and qualifications. G I B S O N COUNTY AUDITOR
Applicant(owner or contract buyer-se 'lions one) lel
Taxing District Key number/legal iption Re u er P ge r
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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 year date of application legal or equitable owner?
❑ 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:AnnuallyAssessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mort gagee or contract seller D
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
•
Name of assignee or other owner or holder of mortgage
r 1 O` �� A
Address of assignee(number and street,racy.state,and ZI M t 0 r1 ,�
Does applicant own property in any If yes,what county? l 1\ 1 ` I,A ,�\'1 l IA_1Nr ,en requested If yes,state amount of deduction
other county 1V x
in Indiana? ❑Yes ❑No /' (� (�,� fes ❑No
A person is not entitled to this deduction unless the p W• `vJ p,r•<9 -- act indebtedness that is recorded in the county
recorder's office(including any home equity line of cr iCe — ( 6 ;is the basis for the deduction.
4-1St co C7
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.
lure eYs lull ul1 name Dale(m'nthl day y^ar)�
Fu' reside t dares of a lica (nu••er and reef,cit h and pale) /V_ IO S
Person authorized by dr executed Power of AH�ey or by IC 6-1.1- 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.