HomeMy WebLinkAboutMortgage_Owen • ;.><. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION ���
-:) .-, State Form 43709(R12/614)
,I. Prescribed by Department of Local Government Finance .-INSTRUCTIONS: ! le .1 t
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. 1A 4-�
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property isMn i a Many y 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 coun ,
where the property is located during the twelve(12)months before March 31 of each year the deduction is
See reverses for additional instructions and qualifice'ens. GIBBON COUNTY AUDITOR
Applicant( er o contract buyer-see ms G , . e.'de) r
g lea 90 Taxing Distn Key�n/u//caber/legal•-s. • '•n n Record number Page rpbQry
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract ind tedness unpaid as o Is the applicant the sole
Mamh 1,anent year March 1,Current year date of appfication /J�/ legal or equitable owner?
0 7 r . ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than(pause,indicate with whom
If name on record is different than that of applicant,indicate below: Is property in question:Annually Assessed
Real Property ❑ Annually Assessed
/] �/�/1 ,`�///n/ (/^/,/r, Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller and street, /\ �i Ur�/�-C
Address of mortgagee or contract seller(num and street,city state,and ZIP code)
Name of assignee or other owner or holder of mortgage _ — • -
(/
Address of assignee(number andstree4 city:st Drawer NO 1-G 0(u,�"
Does applicant own property in any If yes,wh \ m been requested If yes,state amount of deduction
other county Card 1 O >•!
in Indiana? ❑Yes ❑No C r U ❑Yes ❑No
A person is not entitled to this deduction un, / I Q O QL( 1 5-(? -/ Le ontract indebtedness that is recorded in the county
recorder's office(including any home equity (� ( I 1-.__ „••••r: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)
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/ ntract b yer of the afore entione property on date application is filed.
Signature is nam Date(month,day,year)
//3" 67
Ful as ent a ress of app cant number nil street,city,state,and ZIP code)
I 9O 2- /;d,AC �/2-/-vrrsu� /v. i20 7C/
n authorized by duly executed Power o Attomey or by IC 61.1-12-0.5 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.