HomeMy WebLinkAboutMortgage_Pennington (3) -4.9, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
.,. FOR DEDUCTION FROM ASSESSED VALUATION
' State Form 43709(R12/6-14)
''�i1 Prescribed by Department of Local Government Finance
I
INSTRUCTIONS: ' III Mar
To be filed in person or by mail. _
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. I�I
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is JUN 0yy fa4Pty Auditor
located on or before January 5 of the immediately succeeding calendar year. U 1[J'r ouJnty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sougy4r
See reverse side for additional instructions and qualifications.
Applica owner or contract buyer-se 4beraId ons on reverse side) GIBSON COUNTY AUDITOR
_ i a C qt A
Taxing t Record number Page num�5r o?OO -00ciO/s— /7/d value eel propeenyy�$off Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
• ,arrr y rG�� U March 1,current year date of application legal or equitable evileviller?e
/O a S.s _ Gp ❑ 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 belay. Is t property in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller G//�—f/n�/�/l����L .71-g-.N.
Address of mortgagee or contract seller(number nd street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) G
i .Lit.
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
in Indiana? Yes No current year? ❑
❑ ❑ Yes ❑No
A personas.not.entitled to.this.deduction.unless.theoerson has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder ,,-v���,nr L
eall, -ecorded in the county recorder's office)that is the basis for the deduction.
) )G MI') C COUNTY AUDITOR
Deductio ,` L
20. %— / N 4 20 20 20 20
Signature / '7 County Date(month,day,year)
I I We bregoing information is true and correct and that the applicant is a resident of Indiana and
ovine. 3 application is filed.
Signature' owners lull n2me) Date(month,day,year)
Full resident address of applicant(n r and street,city,state,and ZIP code)
x IDO«Q CA-) s c WITf �i I lLSS
Person authorized by duly executed Power of Attomey 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.