HomeMy WebLinkAboutMortgage_Seib (11) C^w{ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year- FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R12/6-14)
?' Prescribed by Department of Local Government Finance g�4�'k
INSTRUCTIONS: F, I I FUe® .
To be bled in person or by mail. -F6}Iff fip:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be bled or postmarked with the County Auditor or County Recorder of the county where the propert)AR 2 • '1dunty 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 .1 *ht.. i�r.-
See reverse s for additional instructions and qualifications. / r firn111•
Applicant(ow, . ontract buyer-sees 'cdon erse side) GIBSON COUNTY AUDITOR
�_ i_ t - . w .I!
T. i . ct Key u tier/I gal description Record numb r Pag u er 40 z 0��-/d-o 2-/Oa? - 00 3. 03//oa-2 da/&o ,�d`�
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract in btedness unpaid as of Is the applicant the sole
Mardi 1,current year March 1,current year date of application legal or equitable owner?
/, 660 111 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
y/Real Property ❑ Annually Assessed
/� Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller jj e.
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage �n
Address of assignee(number and street,city,state,and ZIP code) (� n �/1�/^/,// /� deduction
Does applicant own property in any If yes,what county? What Taxing District? Has is ded`/uJctioonn bee7n requu//jjesesteed..••d If yes,state amo t of
other county on property for
in Indiana? ❑Yes ❑No - current year? ❑Yes ❑No
A person i alance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's S kr‘s0W1/4.p., Se,iV) 4 ,orded in the county recorder's office)that is the basis for the deduction.
K.x, • ` -\. , COUNTY AUDITOR
Deduction: �df \SSc. Je 1 YJ V
�7 c. ,V�. a � l1000
20_ 20 20 20 20
a0IL - '3o(e \- a1- 1L
Signature o County 1 Date(month,day,year)
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(o.ne/s Date(month,day,year)
Ful Jr •-7��f applicant(number street,city,state,and ZIP code)
oN v. J7a,r1 /GGt
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.