HomeMy WebLinkAboutMortgage_Liely CSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R12/6-14) �p--,� g Prescribed by Department of Local Government Finance A IIED
INSTRUCTIONS:
To be filed in person or by mail. n Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. AR 2 3 r iLlS
Must be fled or postmarked with the County Auditor or County Recorder of the county where the prop
is w—I County Auditor
located on or before January 5 of the immediately succeeding calendar year. Co sty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the .: nty• j
where the property is located du ' g the twelve(12)months before March 31 of each year the deduction I(I: ..r7/Tii
See reverse side for additional instructions and lifications. GIBSON COUNTY AUDITOR
Applicantt or co• t buyer-see ri on n rrcVers side)
Taxing / / Ke . /lega l lotion
Record number Page number
'sa Ve �‘, 3/-arao-cbi/11-act 9 1‘, /09 o` .
Ass...-.value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mar 1,anent year March 1,current year date of application efO legal or equitable owner'?
• /7V ❑ 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 tt property in question:Annually Assessed
l�Q Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street.city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage 011 _ /
Address of assignee(number and street.city,state,. ���� �
Does applicant own property in any If yes,what a �U/1 a on been requested If yes,state amount of eduction
other county Y I , �/L1n71 �j
in otheriana? ❑Yeti III No Drawer NO ❑Yes 0 N OC lO�l '/v
A person is not entitled to this deduction unless // it :ontract indebtedness that is recorded in the county
recorder's office(including any home equity line " that is the basis for the deduction,
Card NO.
Deduction approved in the amount of:
20 20_ 20 20 20 20 20
Signature of County Auditor County I Date(month,day,year)
11 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/contract buyer of the af.rementioned property on date application is filed.
/ oaPt4j;2.andzfP7 wn ulln / 1Date
G
address
Person authorized by duly executed Power of Attorney or by IC 6-1w' 4.7 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.