HomeMy WebLinkAboutMortgage_Sisk S7,14,9. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION
� • State Form 43709(R12/6-14)
\ f Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
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.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑ County 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
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner r con t b e - stdct n n re de) a
Taxing District KD number I legal desoiption Record u er Page number
- It -0(9 - ioo-Do4. 311-Oat 93/2
Assessed value of real property as of Mortgage/ tract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1.anent year March 1,c lye pr - r _ date of application legal or equitable owner?
l(/(f�7(f-/) ❑ 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 Prope P Annually Assessed 6
aktatk I 11�1f[i(IC 6-1.1-7)Name of mortgagee or contract seller �9�!Oq Address of mortgagee or contract seller(number and street,city,state,and ZIP code) 1
DEC 12 2015
Name of assignee or other owner or holder of mortgage al
Address of assignee(number and street,city,stare,and ZIP code) G I BSO N COUNTY AUDITOR
[ S1-S K ,rte — - What Taxing District? Has this deduction been requested If yes,state amount of deduction
) ,.mss EPA on property for
i current year? ❑Yes 0 N •
F J u tr :as a balance on the person's mortgage or contract indebtedness that is recorded in the county
it is recorded in the county recorder's office)that is the basis for the deduction:
1 S Cid ON COUNTY AUDITOR
20 _ 20 20 20 20
Signature of Coun A dimr County Date(month,day,year)
Qe ��I"'
I/We erti nder the penalty of pequry tha the a ve nd 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, ignature owner's full name _ Date(month,day,year)
Full resi ent^address of applicant(number and street,city,state,and ZIP code)
fp.a �q W 1765, otvCNsplLL, Ts Li7665
erson authorized by duly executed Power of Attomey 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.