HomeMy WebLinkAboutMortgage_Ward (2) nv STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS I County I Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION
i' State Form 43709(R12/6-14)
1 Prescribed by Department of Local Government Finance
INSTRUCTIONS: File rid.
To be fled in person or by mail. n orrn 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 county where the propertyr+,g-B 2 ; Q�%ounty Auditor
located on or before January 5 of the immediately succeeding calendar year. rr�� 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 so.- t. , ism:r
See reverse side for additional instructions and qualifications. If, . aainH,
Appli nt(owner or contract b u y e r restrict/ on reverse side) . COUxAUB1S8
(/71����� d G / GIBBON
Taxing stria / Key number/legal description Record number Page number
,Z6 - /a-/8 3oY- oo3, o1B -oJ-g I (o G97
Assessed value of real property as of Mortgage I 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?
I °i o 0 0 ❑ Yes ❑ No
1 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: II,..satheep!property in question:Annually Assessed
age-al Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(nu -er and street,city,state,and ZIP code) --_____._ —_
Name of assignee or other owner or holder of mortgage
llraWei- NO.. 1
Addre of assignee(number and street.cit/y,�`ate,and ZIP code) p "'..••••...t..., 1-
..ifie.-t-/t- , 8/27 / — /, i
Does applicant own prop in any If yes,what county? What Taxing District? Has this Card NO. ./. /) ,(//Q 7- i
other county on prone IVVX[[. L ....
in Indiana? ❑Yes ❑No current) 9- ay-/4,'"
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract anti nt.,......___ j
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 Country 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 afor; entioned property on date application is filed.
Signatur (owners fel game) " Date(month,day,year)
k
I ull re ent ad d applicant(number and s -'t,city,state,and ZIP code
.. // feel ) . t:,-),e? `�. , t �&PL
Person authorized by duty 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.