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Home My WebLink AboutMortgage_Knight (2) n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year •!f x FOR DEDUCTION FROM ASSESSED VALUATION • ) I State Form 43709(R12/6-14) \.O1'-'e Prescribed by Department of Local Government Finance. INSTRUCTIONS: Fl- �/ IF To be Fled in person or by mail. Form feed with: Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. OCT. 5❑ xi&ty Auditor Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is 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 where the property is located during the twelve(12)months before March 31 of each year the deduction is so See reverse side for additional instructions and qualifications. G IBSON ['O U NTY AUDITOR Applican o her tract buye s revers sr ,/%e- ' Key umber/legal descriptio/ n Record number Page number - 10 - oo-©031)(13 t l5 / a� ae/ a y9) Assessed current of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant e the sole e March 1,anent year March 1,c rr year date of application legal or equitable owner? I �/J�(,!�(j/� ❑ 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 the property in question:AnnuallyAssessed ❑ Real Property ❑ Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller 9 • /y ,^ r1 v a Address of mortgagee or contract seller(number and street,city,state,and 1(ZIP/I(cod_de)/�`--�J(`J Name of assignee or other owner or holder of mortgage /�/� [� Address of assignee(number and street,city,state,a C. l/_Q LL. . r( k, J ILL Does applicant own property in any If yes,what co I )r a c9O t5 requested If yes,state amount of deduction' other county Drawer N0 in Indiana? ❑Yes ❑No �� J('' ❑No ((�� A person is not entitled to this deduction unless 1 cc4- /C - J 1q3 'indebtedness that is recorded in the county recorder's office(including any home equity line ` 1 the basis for the deduction. y Deduction approved in the amount of: vv„ , "1-11-1"`"" 20 20 20 20 20 20 20 Signature of County Auditor County Date(month,day,}rear) 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 a o mentioned property on date application is filed. Signature(o er- 11 na ) Date(month,day,year) \1� ��> �20� Lodzed-ress of app. ,t(nucity,state,and ZIP code) Pets by duty executed Power 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 510,000.