HomeMy WebLinkAboutMortgage_Fowler rrno STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
1 _ FOR DEDUCTION FROM ASSESSED VALUATION
-' State Fortn 43709(R12/G74)
�' „„ 1 Prescribed by Department of Local Government Finance
INSTRUCTIONS:
F le k1
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- q PR
Must be filed or postmarked with the CountyAuditor or County Recorder of the county where the property is^ n ry Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑::::::BoecRorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the coup where the pmperty is located during the twelve(12)months before March 31 of each year the deduction is
See reverse side foraddtional instructions and qualifications. GIBBON COI INTy
App6canylowner or contract buyer- ruins on reverse side) a. "/F2 )
T " g.( trill Key nu er/legal description .tr'CO.C_/mil.// Record number Page number
oZ& - a3 - /6 - ADD - DOa . $ Y& - o ?.. (1 oi & I, 99a'
erred value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
rch 1,current year March 1,current year date of application legal or equitable owner?
Ib8) 000 ❑ Yes 0 N
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 - I Is the property in question:Annually Assessed
JC_ti.CV 8-�o W \1;,• 1(--- `(r. .1-7)
Name of mortgagee or contract seller
. JCftry st4J V-oraAer ,
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) !-T F- -
‘C)G ( Soo. o .
Name of assignee or other owner or holder of mortgage ao ( -`p
�`e� l l
Address of assignee(number and street city,state,and ZIP code) 3 I Ce- (Cr
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county ,--, property for
in Indiana? Yes El No current year? ❑Yes •❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
. 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
111.1%1 r/contract buyer of the aforementioned property on date application is filed.
Sig" i.wners full name) ��� Date(month,day,year)
Fu II re i 'ddress applicant(nu tier and street,city tat,p,and ZIP code)
k 1e' ' £ (2,, city 75bhstcf- LT u ( 70 39
Person authorized by duly executed Power of Attorney or by IC 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.