HomeMy WebLinkAboutMortgage_Atkinson a°' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
; State Form 43709(R12/6-14) - yyg
„„ Prescribed by Department of Local Government Finance g I e
INSTRUCTIONS: 1g4 _ilt�._JR-
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. Q C ,Q., 9 n'
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is NJ C6mnY Auditor
located on or before January 5 of the immediately succeeding calendar year. 111 Coun Pew der
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 soug
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Applicant or contra buyer-see - frictions oQ%�r�a�'�erse side) & / ttavi ocon
Taxis Di .riot bar/I ai Record number Pa n m
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
O .00 ❑ 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,indica below: Is the property in question:Annually Assessed
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ID Real Properly ❑ Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,s _ -
Does applicant own property in any If yes,wi BYO(� in been requested If yes,state amount of deduction
other county Drawer NO /`
in Indiana? ❑Yes ❑No ❑yes ❑No
A person is not entitled to this deduction ur ontract indebtedness that is recorded in the county
recorder's office(including any home equit. 2 that is the basis for the deduction.
Card NO.
1
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I 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
ner/contract buyer of the aforementioned property on date application is filed.
Si tore owners full ame)„ Date(month,day,year)
1 iciest address lake anber a 'N.state,and ZIP cy�p) n Li' i
Person authorized by duly executed ower of Attorney or by IC 6-1.1-12-0.7 ` (may,•„\ 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.