HomeMy WebLinkAboutMortgage_Dix t rr STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS o
FOR DEDUCTION FROM ASSESSED VALUATIONT t Year
State Form 43709(R12/6-14) t1 ff�
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„„ Prescribed by Department of Local Government Finance JUL 15FG0r AABrk
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. —
Must be filed or postmarked with the County Auditor or County Recorder of the county where the pro
GIBBON COUNTY tY Auditor
located on or before January 5 of the immediately succeeding calendar year A�IF� y
Coun 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 sought.
See reverse side for additional instructions and qualifications.
Applicant(ow rygor contract buyer-see restriction ve side) est (`(\ 1\Taxing District """�`f J 1 Ke L•umber I legal descripti Record number Page number
Assessed value of real property as of Mortgage/Co tract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sale
March 1,current year March 1, i7 ear Q date of application legal or equitable owner?
LiSDItC7 .. es 0 N
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
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eal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
a of mortg ee og r contact seller(�
(er t ._p_
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
o I_
Name of assignee or other owner or holder of mortgage - _ - - -'
Address of assignee(number and
Does applicant own property in an -mount of deduction
other county
in Indiana? ❑Yes (14300
A person is not entitled to this ch v :curled in the county
recorder's office(including any) M f^ on.
Deduction approved in the amount c 0 1 `1 '
0 20 20 Q /--��� 20
Signature of County Auditor o -I 7` vat)
I/We certify under the penalty \G �/ int of Indiana and
owner/contract buyer of the a .
Signature •wner's full name) 'ar)
a. / , 1 l�((l��/ I .
rvrt - 3 1 + l' h L / /addr-
ouly executed-ower of Attorney orb IC 6-1.1-12-0.7 'at(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.