HomeMy WebLinkAboutMortgage_Lewis (2) '"a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
°�`}`,A FOR DEDUCTION FROM ASSESSED VALUATION
sr:mss,
. --4 __j State Form 43709(R12/6-14)
S 1. Prescribed by Department of Local Government Finance [�y-•
INSTRUCTIONS: -1 ',)
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. ���III any
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is MAY I mei"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 so .)r • �' �j
See reverse side for additional instructions and qualifications.
Applicant roapgor contrac buyer-se strictio reverse si e) 4
rrr��� GIBSON COUNTY AUUtTOK
Taxing District(D/, Km number/legal description Record number ?timber
number
6 - g-36- Loa-ccna Cog-009 /� rya
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,anent year March eu nl ear date of application legal or equitable owner?
II O OD • ❑ 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 contact seller
• 13. C/L-clr .eS k
Address of mortgagee or contract seller(number and street,city,sta
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) i v
Does applicant own property in any If yes,what county? — -- 1 If yes,state amount of deduction
other county ❑Yes ❑No
in Indiana?
A person is not entitled to this deduction unless the person less that is recorded in the county
recorder's office(including any home equity line of credit th -o k c - c-: y ra for the deduction.
Deduction approved in the amount of. fj
13 0
1t ),-ob . 00
20 20 20 s rrt SA . �\ 1 1 ) 20
�0 _ �. Jr.. �r.t. \v�.`�
Signature of County Auditor I County ()ate(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.
Si ^ature(owner's full e) , Date month, ay,year)
Full rsident adress of appliica n .- . d sues city,state,\*rid ZIP code) /� „rib ^ 3
Person authorized by duly executed Power of Attorney or by IC 6-1.1-1122--0..7�f G)T� ,\.1(f/� / L 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 S10,000.