HomeMy WebLinkAboutMortgage_Baehl °�t STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
. : FOR DEDUCTION FROM ASSESSED VALUATION
'•� 1' Sta;e Form 43709(R1216-14)
„„v- Prescribed by Department of Local Government Finance ,,t
INSTRUCTIONS:
To be filed in person or by mail. , filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. APR 8 b ti t,
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is IJ County Auditor
located on or before January 5 of the immediately succeeding calendar year. ►5 -. my Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the rt n
where the property is located during the twelve(12)months before March 31 of each year the deduction I'r c f� �� �`
See reverse side for additional instructions and qualifications. GIBSON C•UNTY AUDITOR
Ap t(owner w contract buye_ r-seeresSi d- reverse side) / 7-� 1 „
T ' District �" a rM^Key number/ al desixiption O//�x„ 1tlJ` Record number Pag� rrl§ei
. CO i g Ia 300 ooa. 3 '6-oa s- �S 3
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Morelli,anent year March wrrent r 7� date of application legal or equitable owner?
❑ 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 seller(number ber and street,city,st t ,and ZIP cod -- --- \---- - .-
Name of assignee or other owner or holder of mortgage 'T0-11HN& `-'�-e w� \
cL 3e>-Sly''. Eaavor. ‘3q,C\-S
Address of assignee(number and street,city,state,and ZIP code) I
to \kV-C -- v4 00 U
Does applicant own property in any If yes,what county? What Taxing District? Has this de t
other on property
in Indiana? Yes ❑No current yea a( 1S - l3Qi'3 ‘7_ 1� - is
A person is not entitled to this deduction unless the person has a balance on the person's mortgage
recorder's office(including any home equity line of credit that is recorded in the county recorder's o..-_,
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/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 aforementioned property on date application is filed.
zure(owne/s full name) Date(month,day,year)
0 rAn R(kd.�siden address of applicant(number and street,city,state,and ZIP code)
. 990 u) (Dso S Fa-1 E4'arCh, iN �+71r18
e n 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.