HomeMy WebLinkAboutMortgage_Holmes (2) °a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township Year
'e__ FOR DEDUCTION FROM ASSESSED VALUATION
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State Form 43709(R1216-14) �'^(I ggg
\ e Prescribed by Department of Local Government Finance 1�' 1I1IJ'
INSTRUCTIONS:
To be riled 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. FEB 40 2fJ
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is Auditor
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 1
where the property is located during the twelve(12)months before March 31 of each year the deduction is sou.••„ • • :J n a
See reverse side for additional instructions and qualifications. GIBSON COUNTY Al1DITOR
Applicap vner or contract buyer-s e re,tio on reverse side)
T istricl Key number/legal description Record number Page number
/ tnt-ta-ro-n_9 ACa - /l -/A - /03 - 00/. S, 5- 0 -2- g "Co, 3 L 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 applicati n legal or equitable owner?
applicati
500 ❑ Yes ❑ No
If no,what is his I 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
A - atAefc..-Kai v—'- A„Zerr-n -4
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 codes ra}}per 11rO / ... /J
t2d w-e.t_, M //5 Car .Q�/XO 7�
Does applicant own property in any f yes,what county? What Taxing District? Has ih Card N0 0• on
other county on prop,...- '••.• 570
in Indiana? ❑Yes ❑No current year? — / C/
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract inner.._- 9-�j- ••'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 rno.. `CC
COUNTY AUDITOR .
Deduction approved in the amount of:
20 20 20 20 20 20 20
I Signature of Count'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
owner I contract buyer of the aforementioned property on date application is filed. _
Si �,(\own=r ame) I Date(month,day,year)
\ /C+^e' �--,
\y/ cull resident address'oIf ap licant(number and street,�ci7fy,,state,and ZIP code) Pr/� 7-4-1-0
I I 'V l K!•e.ST- 8 r ,-)In -r'�vl ' c, .r tt.IC�C A-/�f1--, 'i
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 10,000.