HomeMy WebLinkAboutMortgage_Duncan no STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
,-.A FOR DEDUCTION FROM ASSESSED VALUATION
4
State Forth 43709(R12/614)
•%.Ill Prescribed by Department of Local Government Finance
INSTRUCTIONS: I ' ark
To be filed in person or by mail. �g(e ' orm filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduct' is sougg L
Must be filed or postmarked with the County Auditor or County Recorder of the county where the pro e r ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. JUL L015 ❑ County 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 soup t
See reverse sid additional instructions and qualifications.
Applicant(owner c ntrad buyer- a restricfio n reve de)
/ � , GIBBON COUNTY AUDITOR
Taxing District Kam/(/numb eppl i i '_W ® RN
� r Page ylnbo ri
7 10 l�/\ a 0—0 2��a� o� 6
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,current year date of appfication legal or equitable owner?
l/O 1 irD 6 ❑ 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 belay. Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller (/ / 1 c U
Address of mortgagee or contract seller(number an et,Q,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 co equested If yes,state amount of deduction
other county ❑No
in ersni ❑Yes ao 15 0 N county
A person is not entitled to this deduction unless 1 'ndebtedness that is recorded in the
recorder's office(including any home equity line Drawer N O he basis for the deduction.
Deduction approved in the amount of. \r .80 7
Card O. . .. ••
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20 20 `w lY f t C• . 20 20
I I I
Signature of County Auditor County Date(month,day,year)
I 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 I contract buyer of the aforementioned property on date application is filed.
ig lure(owner's full/nnamme))� I Date(month,day,year)
ull r t zddr" of appfi�nt(nn� r and street,u Late,and ZI de
I. 5 ! /00 A&c, —&147(oy g
Person authorized by duly executed Power of Attorney or by IC 61.1-12-0. 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.