HomeMy WebLinkAboutMortgage_Seib (4) Sa_?ziN STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
_i FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R12/6-14)
;,;; Prescribed by Department of Local Government Finance —
INSTRUCTIONS: j" l:�1
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. �,II��II
Must be filed or postmarked with the County Auditor or County Recorder of the county where the prop�tFist 1 2 a 1 c County Auditor
located on or before January 5 of the immediately succeeding calendar year. r CD 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 two We(12)months before March 31 of each year the deductio`- sogght.4 :r—
See reverse side for additional instructions and qualifications. ■'ry -Vl,7.
ApplicannwAowner orr�cantrad buyer-see restrictions on reverse side) GIBSON COUNTY AUDITOR•Taxing Dis`nty1–}r 6 KO number/legal description `a S Q{ R1e�.c=lJyAl`,number T ben
Assessed vahk U real property s of 6- Mortgage� 31COn� indebtedness as of Mortgage O n indebtedness unpaid
01
Is the applicant as
March 1,current year March 1.current year date of application legal or equitable owner?
4'./ a 7a.. °O Q Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
It 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 ortgagee or contract seller
MEftwn LeAdirs .
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) �� 1
Zoo The. Tr� • St i +h -ii r StJiC �u ,-tSU; ! � 3 L
Name of assignee or other owner or a of mortgage n
Address of assignee(number and street,city state,and ZIP code)
Does applicant own property in any If yes.what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county I��� on properly for
in Indiana? ❑Yes [ *Jo 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 information 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.
S' nature(Dior s full nor 1.00E) A - n Date(month,day,year)
Full r dent ad ress of applicant(number and eet,city,state,, /`idd ZIP code)
car i S Set and 41.0$6-f4Di lady
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 510,000.