HomeMy WebLinkAboutMortgage_Dunn Sr t STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R12/6-14)
r" Prescribed by Department of Local Government Finance
INSTRUCTIONS: FILED�i ILED File Mark
To be filed in person or by mail. �L Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the gqu6l',ytgrC�tp�,.property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. r CIS G 3 ZU 10 ❑ 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 a year th de ction s sought.
See reverse side for additional instructions and qualifications.
Applicapt(pwn o�r Ty rcon:>act buyer-se strictions on�+r�rse side) ^ GIBBON COUNTY AUDITOR
Taxing :stria nvrlv,M• Key number l legal lddee/sscrptitioonv,_'_, V\/,` Record number Page number
dek 1 s • 1o30oa SID- oa8 16 5gy
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 application legal or equitable owner?
519$0 ❑ 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 n'uac seller
r
Address of mortgagee or contract seller(number and street,ci g state,and ZIP c e)
Name of assignee or other owner or holder of mortgage ( f'�
Address of assignee(number and street,city,state,and ZIP a 0 ` 1 n 1 0 'in L(c
Does applicant own property in any If yes,what county? 1 ted If yes,state amount of deduction
other county A1'
in Indiana? ❑Yes ❑No p`k c 4- e— \`CS No
A person is not entitled to this deduction unless the pers 'edness that is recorded in the county
recorder's office(including any home equity line of credit cck lC) l�l�t j i sis for the deduction.
Deduction approved in the amount of:
a-n -/q D6/ t - 5icy
20 20 20 ^ j� 20 20
Signature of County Auditor 1 X �J Date(month,day,year)
t UUU
I/We certify under the penalty of perjury that the abut. J pplicant is a resident of Indiana and
owner/contract buyer of the aforementioned property
Signature(owner's full name) I Date(month,day,year)
/lliAta► 1 d .uns, s R.
Full resident address of a plicant(number and street,city,state, ZIP code)
1 330 �.aQ (�n.� �jn Li 7(07 0
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.