HomeMy WebLinkAboutMortgage_Whitfield "a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
1-;q FOR DEDUCTION FROM ASSESSED VALUATION
- State Form 43709(R12/6-14) •
„< Prescribed by Department of Local Government Finance
INSTRUCTIONS: F e,E
To be filed in person or by mail. F 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 S EP 1❑cj!ty 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 file with the County Auditor of the county
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where the property is ted during the twelve(12)months before March 31 of each year the deduction is so
See reverse side for additional instrucb' ns and ualification . )N.1�7
Applicant(o = or contract buyer-see trictii1ons nryve es' e)` GIBSON COUNTY AUDITOR
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Taxing 0s Key nu b rllegption Re dnumbe Pa number
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„value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract' e ness unpaid as of Is the applicant the sole
• 1,current year March 1,current year 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 sbouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is j3e property in question:Annually Assessed
Real Property ❑ Annually Assessed
/ Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller / �t
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Address of mortgagee or contract seller(number and1, ity,state,and ZIP code)
Name of assignee or other owner or holder of monger ��y /r ss
Address of assignee(number and street,city,state,and ZIP code) c
DI at Taxing District? Has this deduction been requested If yes,state amount of deduction
of on property for
in /W 1 current year? ❑Yes ❑No
AI balance on the person's mortgage or contract indebtedness that is recorded in the county
ter /�_ n l.��—_ '_ ecorded in the county recorder's office)that is the basis for the deduction.
�t� COUNTY AUDITOR .
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20 20 20 20
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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.
1 Signature(owner's fun name) Date(month,day,year)
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'II.las." • .Aa AA 1 i1 - I - 1J
resident address of applinnt(number and et,city, ate,and ZIP code)
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Person authorized by duly executed Power of Atto0.7 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.