HomeMy WebLinkAboutMortgage_Steiner a ,r74 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township I Year I
eFOR DEDUCTION FROM ASSESSED VALUATION
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State Form 43709(R12/6-14)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: F 01 ice.
To be filed in person or by mail. alp ,h
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sou . �! :�/���/
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is I U County Auditor
located on or before January 5 of the immediately succeeding calendar year .MAR y4 O County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the MARy4
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. n,
Applicant(owner or contract buyer-see restrictions on re i se side) �JNJa(
GIBSON COUNTY AUDITOR
T ' District Key number/legal description Record number Page number
a6- //-AC- yoo - 000. 733 - o J. ) /5 S/6 ✓
Assessed value of real property 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?
W% 000 ❑ 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 or contract seller
Address of mortgagee or contract se er(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
,
Address of assignee(number and street,city,state,and ZIP code) S Tent f-2
QT sE 2 5 .z l r 3. o A-c M4 rry0j
Does applicant own properly in any If yes,what county? What Taxing District? Has this d
other county on proper A M��
in Indiana? ❑ r1 Yes ❑No current yr ,,A
A person is not entitled to this deduction unless the person has a balance on the person's mortga '
recorder's office(including any home equity line of credit that is recorded in the county recorder's 15-516 3
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 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 aforementioned property on date application is filed.
%,I Signature(owner's i Date(month,day,year)
-Ni, Full resident address of applicant(number and street,city,state,and ZIP code)
lx 7g W 350 S er:,4 �� / i—nl yJevO
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.