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oa STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
S FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R12/6-14)
4—44 Prescribed by Department of Local Government Finance - - -
F Ill Ma
INSTRUCTIONS:
To be filed in person or by mail.
Filing Oates: 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 R County Auditor
located on or before January 5 of the immediately succeeding calendar year. OCT �-( ydtIy Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the dal instructions is i located s and the twelve(12)months before March 31 of each year the deduction is soug
reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side) r
JOHN T. WAGGONER GIBSON COUNTY AUDITOR
Taxing District Key number/legal description Ref-ber PagtEgb�/%/J
OAKLAND CITY 26-14-18-304-000.040-007 //�-//jj/'r/5
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?
$ 105,061.00 p 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 deferent than that of applicant,indicate below: Is the property in question:Annually Assessed
17 Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
NATIONS LENDING CORPORATION •
Address of mortgagee or contact seller(number and street,city,state,and ZIP code)
4 SUMMIT PARK DRIVE, SUITE 200, INDEPENDENCE, OHIO 44131
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? VVnat Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes 12 No current year? ❑Yes ❑No
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
Signature of County Auditor County Date(month.day,year)
I/We certify under the penalty of perjury that the above and foregoing intonation 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. .
i ure owners tu�d 3fe) Date(month,day, ar)/� �" 09/ /2015
Full r dent address`ef-applicant( mber and street,city,state,and ZIP code)
2 4 S. Main Street, Oakland City, Indiana 47660
Person authorized by duly 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$10,000.• •