HomeMy WebLinkAboutMortgage_Short (3) ^a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
MEI
State Form 43709(R12/6-14)
;; Prescribed by Department of Local Government Finance
•
INSTRUCTIONS: File Mark ilk
To be filed in person or by mail. Form filed 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 7ele p is County Auditor
located on or before January 5 of the immediately succeeding calendar year. ^' n � Lu'"
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county County Recorder
where the property is located during the twelve(12)months before March 31 of each ye rj jhe ded do ' ught.
See reverse side for additional instructions and qualifications. •�(�(p
Applrant, (qu7�er or contractbuygr-see restrictions reverse side) e GIBSON COUNTY AUDITOR
tZ�O`YS G// /rl/ �' g��LPit &inm < J`1cn�
T n District %Key num legal description Record n tuber Pale num
on 7 - ia- 36-your i. 93a 0Q C� ,
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,current year March 1,wrrent year r date of appli ation legal or equitable owner?
r Q c25 a� ❑ 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 Isth^e property in question:Annually Assessed
Er'Keal Property ❑ Annually Assessed
__ • Mobile Home(IC 6-1.1-7)
Name of nwrtg;fgee or contact seller ^ n/� ,.,
Address of mortgagee (number street,city,state,nd ZIP de)
Name of assignee or other owner or holder of mortgage
Address of assignee(number ar
Sr
Does applicant own property in: rs this deduction been requested If yes,state amount of deduction
other county I property for
in Indiana? ❑Yes ❑ �"' irrent year? ❑Yes ❑No
A person is not entitled to thi nortgage or contract indebtedness that is recorded in the county
recorder's office(including a / ' — 155 5 irder's office)that is the basis for the deduction.
Deduction approved in the amo
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.
Signature(o NO name:'c e - Date(month,day,year)
s-- /
Full resident address of applicant(number and street,city,state,and ZIP code)
Ve .
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$10,000.