HomeMy WebLinkAboutMortgage_Ewin •^•'.v STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
4 FOR DEDUCTION FROM ASSESSED VALUATION
-- -- State Form 43709(R12/614)
• „„ Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. DULY ENTERED reIR fiTAMT:ION
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought,_, ,^ ( al acc a t'�� ,�IEjd'f
Must be tiled or postmarked with the County Auditor or County Recorder of the county where �44enl'f -� !7
located on or before January 5 of the immediately succeeding calendar year. day of ❑ Cr.y.,ty Reeerder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property i s located d u r i n g the twelve(12)months before March 31 of each year the ded(coon is sought.
See reverse side f dditional instructions and qualifications. Auditor
Applicant(owner or ctb r-see restrictions on re2 e side) • 4 � IDSOn ouny
..a 4 1 r • 4 a- e{ i!'1 Parcel #
Taxing District Key number/leg i- .'priori Record number Pa a number
6p•03-aoo- teal 9-co 1 l4 X353
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 ofappypljgns_� legal or equitable owner?
(�/�IY3 ❑ 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 theFeJinII o}t`Anou / essed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or cont-act seller j4-c oD 1JJ
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) _
GIBSON COUNTY
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) /A1
Does applicant own property in any If yes,what county? a0/ / .,•..• requested If yes,state amount of deduction
other county Q,...
in Indiana? El Yes ❑No Dra\\'Ct 0 w
A person is not entitled to this deduction unless the pens 'ndebtedness that is recorded in the county
recorder's office(including any home equity line of credit ***.....••• 4e basis for the deduction.
Card i\°. ••-..
Deduction approved in the amount of:
20 20 20 I 20 20 ~ 20 20
Signature of County Auditor County Date(month,day,year)
I/We ce 'fy 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
ovine r act buyer of the aforementioned property on date application is filed.
5{•• re ?lit`r's fuD name) Date(month,day,year)
Full�l rest drgss of appJtranl eanIn free ,,state,gpQZIP ) A)_ 4.7, , Q
Person�/authorize/d/d by duly executed`JPowwee)rr ,of Attorney or by IC 6-1V.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.