HomeMy WebLinkAboutMortgage_Meny (11) ^ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION
j ` State Form 43709(R12/6-14)
'--„� Prescribed by Department of Local Government Finance i� IFS .
INSTRUCTIONS: II aj M• '.I
To be filed in person or by mail. Form tiled with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. FE• lit AMA,
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ' 11aLruy 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 Re with the County Auditor of the county II
where the property is located during the twelve(12)months before March 31 of each year the deduction is sou..n'8-0 7r771
See reverse side for additional instructions and quad ations. GIBBON UNTY AUDITOR
Applira• /; •r contract buyer-- e res`dctions on•/erse side)
F,4011117 a Key . ••er_ egal description 6O Recod number Pa•- 07 mb
n.value of real p rty as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole .
lir• 1,anent ye March March 1,current year date of applicatig707 � legal or equitable owner?
//-((-/✓7 L� / ❑ Yes ❑ No
If no,what is his/her exa hare of interest? If owned with someone other then spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
� �/V Real Property ❑ Mobiley Assessed
�! ��sWic.-�� Mobile Home(IC G7.1-7)
Name of mortgagee or contract seller Address of mortgagee or contract seller(number and stretate,and ZI code)
Name of assignee or other owner or holder of mortgage y/ Fes'/�//. K�t��a,�
Addre of ass' (n ber nd et,city, to and ZIP code) ��C-. / ! // ///
Does ap ❑,a t own roperty in any If yes,w county?
at Taxing District? Has thi eduction been requested If yes,state amount of deduction
other county on property for
in Indiana? Yes ❑No _ current year? ❑
DI ❑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 c'' - __
20 20_ 20 20_ 20•
Signature of County Auditor Drawer NO CYOI5 Date(month,day,year)
I I We certify under the pens 5507 true and correct and that the applicant is a resident of Indiana and
ow er/contract buyer ofthe Card NO.
Signet re(owner's fulllln`om 4'70 MY1 IN Date(month,day,year)
Full a e^Wnt,l address of appli n(n-umber a-nAtreet,city,state,and ZIP code)
l
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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.