HomeMy WebLinkAboutMortgage_Koca nra STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_? FOR DEDUCTION FROM ASSESSED VALUATION
IP
�� State Form 43709(R12/6-14) '
;i� Prescribed by Department of Local Government Finance
INSTRUCTIONS: FILE '.r' File Mark
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 ofg@tourtwU} he property is unty 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 County Audi or of the county
where the property is located during the twelve(12)months before March 31 ach uction is sought.
See reverse for additional instructions and qualifications.
Applicant(ov r. yntra buyer reshicti GIBSON CUUNTY AUDITOR
, ey nurrAbber legal descdp on Record number Page number
i 61.CO -1a-V7-c20/-too,348-001,),., 1 S 19 a a.
Assessed value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,ourtent year . i date of application legal or equitable owner?
. J/0oU ❑ 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
/� �/J��(�/! ❑ Real Property ❑ Annually Assessed
�//`- ��V C tL(?� Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller
Address of mortgagee or contract seller(number and street,city,slate,and ZIP code
1---'4 acsionee or other owner or holder of mortgage
-U V r
C�,J��'y ' I v-q�C ' What Taxing District? Has this deduction been requested If yes,state amount of deduction
j ` t C� on property for
S G .b a J current yea/1 ❑Yes ❑No
t son has a balance on the person's mortgage or contract indebtedness that is recorded in the county
Q U I S. — Pt dit that is recorded in the county recorder's office)that is the basis for the deduction.
I. S— tS— (S- COUNTYAUDITOR .
Deduction approved in the amount ui.
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/contract buyer of the aforementioned property on date application is filed.
Si ture(owner'ss/full name) �r �/// Date(month,day,year)
✓a,� .4,. IL6�L-
u0 resident address of applicant(number nd sheet,city,state,and ZIP code) �p
f� 3zf C CSle� c1GtP Si--- �rr ice s�� t_g_ 5 76775
�W I erson authorized by duly executed Power of Attorney 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.