HomeMy WebLinkAboutMortgage_King STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township b ar
4,14, FOR DEDUCTION FROM ASSESSED VALUATION
i` Sate Form 43709(R12/6-14)
. Prescribed by Department of Local Government Finance
INSTRUCTIONS:
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. JU_ ,.]., 'n'f,
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is u Cb1SAlYAuditor
located on or before January 5 of the immediately succeeding calendar year. ❑ Count 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 arch 31 of each year the deduction is sough.
See reverse : .-for additional instructions and qualifications. GIBSON COUNTY AUDITO R
Applicant .w'-
Be res 'Chan n verse side) / D
� nSt T- mis t Key mher legal de tan Record number Page number
1 �� -�3 i , d a�/ a o07 016/5- .901O 0Z
4.,-.>.value of real .•as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,current yea / March 1,current year date of applicailyn legal or equitable owner?
Al '5—oda ❑ Yes ❑ No
If no,what is his/her e 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: ,I,s the property in question:Annually Assessed
(](r<eal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
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,and ZIP code) �/�/ /�, /2 cr
Does applicant own property in any If yes,what county? What Taxing District?l/y�(,{/1 H is deduction been request d If yes,state amount of deduction
other county o operty for
in Indiana? Yes ❑No current year? ❑
ID Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
AUDITOR
Deduction approved in the
Drawer /Drawer O v�V/
20 ^ 20 20 20
Signature of County Audit Card NO. Qc7ce z,, County Date(month,day,year)
r—
I I We certify under 1 _ _ motion is true and correct and that the applicant is a resident of Indiana and
Aowner/contract buyer of the aforementioned property on date application is filed.
/\ Signature(ownegs full name) Date(month,day,year)
'1/4-YA-�4).A(ohtplr nt(number -L�-
Full resident ddress of applicant(number and st et,city,state,and ZIP code)
((9 AJr 2n) ll. )4J1c. ®a a-.." �_ �m. 'I'2[al0
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.