HomeMy WebLinkAboutMortgage_Drake EmSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
j State Form 43709(R12/6-14)
Prescribed by Department of Local Government Finance a
INSTRUCTIONS: File Math
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 c( ctifn is mgt.
Must be filed or postmarked with the County Auditor or County Recorder of the dsrty ,kherdYHA'property is County Auditor
located on or before January 5 of the immediately succeeding calendar year. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the untyA itor he-county
where the property is located during the twelve(12)months before March 31 of tion is sought.
See reverse sid r additional instructions and qualifications. - GIBSON COUNTY AUDITOR
Applicant ne or ce ct buyer eelres c son reverse i )
, 7�
T. •District Key num /legal description `w1„(J_Lyy Re Rid nu r Pag umber
gp e� I OUP -1a-07-304-cos. o-)q--oaa CID X70
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 rr t ye r�y� date of application legal or equitable owner?
T�^r ❑ 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
513
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)
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
t in Indiana? ❑Yes No current year? ❑
❑ 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.
COUNTY AUDITOR
Deduction approved in the amount of:
20r`�, 20 —I 20 _ 20 20 20 20
Signaturolof fumy Auditrv� County Date(m da ar)
I/We c p l w el -egoing information is true and correct and that the applicant is a resident of Indiana and
owner I 1pplication is filed.
Si nature(o �r •"" Date(month,day,year)
`a- Card N0• • ,fin
Full r-sident a _,c, � Tv— i-/ 770
Person auth•rt -. cower of Attomey or by I o-1.1-1 -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.