HomeMy WebLinkAboutMortgage_Akers (3) ^•>: STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
ct FOR DEDUCTION FROM ASSESSED VALUATION
�� State Form 43709(R12/6-14)
'> Prescribed by Department of Local Government Finance F Iela ,
INSTRUCTIONS:
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. rtV "
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is Nall .408pc itor
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 sought.
See reverse side for additional instructions and qualifications. GIBSON CO
Applicant a or contract buyer-s licriens qn revers " e) /, COUNTY AUDITOR
Taxi Istria A/ ey number/legal legal description /`O Record number Page number
-�Q�//`// rid- /-/S-/Q/- odoT. 00 i Od V) P.or (o !90 Y
value of real prdperty f II Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,Current year date of application.¢ ...re legal or equitable owner?
A OAS. ❑ 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 efferent than that of applicant,indicate below Is,thhe property in question:Annually Accessed
Real Property ❑ Annually Assessed
` Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number end street,city,state,and ZIP code) - -
Does applicant own property in any If yes,what county? What Taxing District? Ha M\G 0. C - `` Z'r S p
other or C
Th-
in Indiana? E?
di yes ❑No a' \ E CAN-- as i c_ t c\69
A person is not entitled to this deduction unless the person has a balance on the person's i x `s , iJ mty
recorder's office.(including any home equity fine of credit that is recorded in the county rea I V 3. O b
COUNTY AUDITOR — 6_'
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I 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.
" ( ) Date(month,day,year)
sA S' lure owner's name
ms.,F`uullll l`l rSsid(`ee I addl`ress of appfi t(numbii-6_ranint
a scree u ate,and ZIP
'17code) r�
Person authorized by duly executed l Power. Attorney Pron.6 n i �� 47 7O 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.