HomeMy WebLinkAboutMortgage_Umpleby Jr 0•emSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION• State Form 43709(R12/6-14) '
,,,, Prescribed by Department of Local Government Finance rg��
To
INSTRUCTIONS:
person �l a �
To be filed in person or by mail. o
Filing Oates: 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 property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. J U 31 Cfp24 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 additio instructions and qualifications. • n
Applicant(owner or contract bu -see stdctions on reverse side
'W' GIBSON COUNTY AUDITOR
Taxing District Key umber/legal descnp' Record nu er Pa a number
deb-05- 40- 181- aD . '?4fr va. Ja 3(f 3
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indeb edness unpaid as of Is the applicant the sole
March 1,anent year March 1,current year dateff�pplIt�;iOn legal or equitable owner?Ozt yU� /J_ ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone oder than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or conhac c y;
I ____• ..__.... .. _ _ ________
Address of mortgagee or contract seller(nu 4.er and street,city,state,and ZIP code) ^-tin,) eafa
Name of assignee or other owner or holder of mortgage 0
Drawer NO••
Address of assignee(number and street,city,state,and ZIP code)
.
ail ......
Does applicant awn property in any If yes.what county? What Taxing Dish Card NO. •••••••.. ... F deduction
other county 11 O
in Indiana? ❑Yes ❑No d1 i S[ COO O_
A person is not entitled to this deduction unless the person has a balance on t y� J/COO —u„c coat is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the —way a ecoroers office)that is the basis for the deduction.
COUNTY AUDITOR .
Deduction approved in the amount of:
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 re nets full
'`name) • Date(month,day,year)
0�std address of applicant(nu,ber and ire city,state,and ZIP code)
• Zt. �j s . n MAt b
Person authorized by duly executed Power of to~��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 S10,000.