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HomeMy WebLinkAboutMortgage_Elliott (3) .A STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township I Year FOR DEDUCTION FROM ASSESSED VALUATION T State Form 43709(R12/6-14) g L.ED � i' Prescribed by Department of local Government Finance INSTRUCTIONS: To be filed in person or by mail. FQQf1;r�rnp1�:filed with: Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. JAN 1 1 2ya}r Must be filed or postmarked with the County Auditor or County Recorder of the county where the property rs jLJI County Auditor located on or before January 5 of the immediately succeeding calendar year. IA •. Recorder 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the c= t - A :i where the property is located during the twelve(12)months before March 31 of each year the deduction t-—1 t. . "1"?' See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR Applicant ner or contract buyer-see restrictions on reverse side) Tax' District Key number/mber/legal Record number Page number AC0 — / 2. - / 7 youo_ 000. 187 . 0 ,),7 a0i..5" SoX' Zr, Assessed value of real pf Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole March 1,anent year March 1,current year date of a plication legal or equitable owner? Y6 79 . ❑ Yes 0 N If no.what is his/her exact share of interest? If owned with someonetother than spouse,indicate with whom If name on record is different than that of applicant,indicate below: Is the property in question:Annually Accessed ❑ Real Property ❑ Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract 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,state,and ZIP code) PT !,-> se 0 - .2. - ,0 / 4 C Does applicant own property in any If yes,what county? What Taxing District? /' coon other county in Indiana? ❑Yes ❑No A person is not entitled to this deduction unless the person has a balance on the perso county recorder's office(including any home equity line of credit that is recorded in the county al'— COUNTY AUDIT( Deduction approved in the amount of: Ga+ 1 20 20 I 20 20 Signature of County Auditor County U �c�cv-a— _ C L and x",`aa`11\ I/We certify under the penalty of perjury that the above and foregoing information is tr �SC> �� 5 owner/contract buyer of the aforementioned property on date application is filed. ,.,_ � Signature(owner's full name) �- 1 n ^ t l5 1 °(� ` N C/' V C[d�+., 1 VFull resident address of applicant(number and street,city,state,and ZIP code) I)3y E /s©s 7rl,+o It! '17('C) 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 S/0,000. •