HomeMy WebLinkAboutMortgage_Horrell STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count ' Township Year
4 FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R12/6-14)
\ �+ Prescribed by Department of Local Government Finance MIL P f l 1
INSTRUCTIONS: ■ e a i.)
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. F66C$ C�81 C.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is r❑D t6 tiditor
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 sough Iii7rr��rtn1%
See reverse side for addi bnal instructions and qualifications. GIBSON COUNTY AUDITOR
Appli .-.!owner rn.ract uyer-see�estnc6 n on reverse ides) o / a
Key number/legal description Record n r e Pewter Tai if </a c - o5-Ja-/do— 09/ 9d9— 00?7
• messed 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,arrrent year March 1,current year date of application,[[�/ /, legal or equitable owner?
t�v ❑ 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:Annually Assessed
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,cit) °
� oNln!,l !�, gym
O 4/94.,/94.,
Does applicant own property in any If yes is deduction been requested If yes,state amount of deduction
other county pertly for
in Indiana? Yes No ❑
t year?
El Yes ❑No
A person is not entitled to this deduction I ' n gage or contract indebtedness that is recorded in the county
recorder's office(including any home el I b - 1--1 J Li is office)that is the basis for the deduction.
-
Deduction approved in the amount of: 111 ((ll
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 information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the afor entioned property on date application is fled.
Signature woee till n e) Date(month,day,year)
Full id /7 re of applica umber d s e{3(,city,state and ZIP
'/�r .rib [ < 6
Person autothorzed/by duly executed Power C_offAAAttt/ornrney(oor by IC 6-1.1- 2-0.7 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.