HomeMy WebLinkAboutMortgage_Marshall •.ro. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
.i`� :t FOR DEDUCTION FROM ASSESSED VALUATION
:='=1I State Form 43709(R12/6-14) -
•6 Prescribed by Department of Local Government Finance lip
'.t File Mark
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 whicp,(bp,de4u hp sought.
Must be filed or postmarked with the County Auditor or County Recorder oo7bjf cob 4A6i'd the property is County 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 wit a Cou A ito he county
where the property is located during the twelve(12)months before March deduction is sought.
See reverse side for additional instructions and qualifications. GIBBON COUNTY AUDITOR
App6nnt(owner contract buy eR-see'e s, std= 1 1
1 g m
T Daung District Key noir r/I-q descri tion Record number Page number•ffil'1 b /'ll-c��-�.0t-C'b 0.ct�-� d o is' ..3 9 4' l
Assessed value of real property of Mortgage/Contract indebtedness unpaid as of Mo age/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,Current year f application legal or equitable owner?
. V fO ` ) ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone oiler 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 cnttract seller 1 i — - ---
Address of mortgagee or contract seller(number and stye-fi city,state,and ZIP code)
b ^���� �/) 1
Name of assignee or other owner or holder of mortgage `` 1/ 10 I r I r'
Address of assignee(number and street, r O —
g ( city,state,and ZIP code)
Does applicant own properly in any If yes,what county? What Taxing District? Has b.._ ..___... .__ ............................
other county on property for
in Indiana? ❑Yes ❑No current year? ❑Yes ❑No I
A person is not entitled to this deduction unless 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 20 20 20 20 20 20
Signatu 4 L•unylwdtor • / I County I ' Date(monjt^�d�.l,yea
_.♦ 1 J ) _ /Aa . .L '1 lid. ill.t_ V 1-
I I We certify under the penalty of perjury that the above and •regoing 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. •
S t ii •wne?s full name) / Date(month,day,year)
_r. S /2:._ / / ��� .
Full resident address of applicant(number and street,(Sy,state,and ZIP code)
\0 75dR S .R70 C , fort 1 4cll J A) `/ 7cYg
erson authorized by duly executed Power of Attomey 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 510,000.