HomeMy WebLinkAboutMortgage_Altgilbers (2) r�^'i STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County fl p, �1Y r
\-�p : FOR DEDUCTION FROM ASSESSED VALUATION
>:i='> ^t" State Form 43709(R12/6-14)
'';"u' r Prescribed by Department of Local Government Finance
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INSTRUCTIONS: IJElla* 2015
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 of the county where the property is ,, • —fin; /'uditor
• Wi,
located on or before January 5 of the immediately succeeding calendar year. Gipson: �1 N Mtf bf?I
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 additional instructions and qualification
Apatite/ • contract buyer-see rrj6 ri u'odso reyerseki )
7axi1-nis V ey bet/ al description / .1� od P Record Page ue/ erg
/1-74i l/VVV/ o �- o?-/ /a/- ll U J/ CX is ; 0
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebted gips of Is the applicant the sole
Mardi 1,current year March 1,current year date of application / //gips legal or equitable owner?
(p , all 0 ❑ 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: \IIss the property in question:Annually Assessed
j Real Property ❑ Annually Assessed
C y Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller ///a- /��
•Address of mortgagee or contract seller(nu r and street,c"te,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 county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes ❑No current year? ❑Yes ❑No
A person is not entitled to this deduction un less the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR .
Deduction approved in the amount of:
--------
20 1 20 I 20 20 _
Signature of County Auditor County /
Drawer NO''''... '
Ii We certify under the penalty of perjury that the above and foregoing information is true �
owner I contract buyer of the aforementioned property on date application is filed. „/ •y>•..
Si. e wne?s full na - . . / Card NO. ••••!/`
Full sent addry=of appli .•'t num:°rand street,city,state,and ZIP code) 1
X &13 ET • ei ft/tfy c-I- Pre u(<k't) . e.t) I-t7(r'/ (/
Person authorized by duly executed Powe}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 S10,000.