HomeMy WebLinkAboutMortgage_Ochs .5.4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
1'° FOR DEDUCTION FROM ASSESSED VALUATION
,
: a-`_-, State Form 43709(R12/614)
Prescribed by Department of Local Government Finance F IL „is Imo,
.) File Mark
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 deduc vile
• Poperty is ounty 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 We with the ny Awl'or f he my
where the property is located during the tweve(12)months before March 31 of e r on is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner r-see restridiops�Pn re side_ GIBSON COUNTY AUDITOR
TazjRglDistn� Key number/legal d/e/saiption'� Recorrer Pa a nu
Assessed value of real property as of Mortgage/Contract indebtedness unpaid.cs of Mortgage/Contract indebtedness un as of Is the applicant the sole
March 1,current year March 1,current y 459 / (J(J date of application legal or equitable owner?
❑ 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 A«eesed
❑ Real 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 T"1 O
Does applicant own property in an —tat ( T ` — .amount of deduction
other county v ` -T-
in Indiana? ❑Yes ❑Ni
A person is not entitled to this r i /SL v } econled in the county
recorder's office(including any (:\ � ;don.
h
Deduction approved in the amount (� �I
C
20 20. \�'' of 20
Signature of County Auditor n. ry,year)
I/We certify under the pens — \ ;Went of Indiana and
owner/contract buyer of tit --1/4-y....
Si.nature(owner's full name) Y yea/
ta, S. .
ip ' ent address of applicant(„m,,,.,aim queer,wy,scare,ano LIP code
COCA, S. Coo: to -IUD S4 . code
���e-(- --) ' Yom. Lf74?d
Person authorized by duly executed Power of Attooey 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 510,000.