HomeMy WebLinkAboutMortgage_Houchin (2) •
SSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R12/6-14)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
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 where the p lIt1 Auditor
located on or before January 5 of the immediately succeeding calendar year. .. ty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of co �
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. JUN 2 2016
A p p li c a n t(owner or con uye r-see sfricuons on reiee side) v/I
•
Taxing District Ke umber/legal descri tion R a r
a(�_-1LI—IX - ;Da-ocx� ti 002 GIBSONCOUNTYAU�f� its
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 1,curgapttsgr— �� date of application legal or equitable owner?
'I '0(1 ❑ 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
r Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller
• "Tao 1->Q ;
Address of mortgagee or contract seller(number an f street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP
dykes \Ao���:.v`
Does applicant own property in any If yes,what county? 1 V- - rested If yes,state amount of deduction
other county ❑Yes ID \c� \\�e. \4\0.ti C\ - ZV�C. DNo
in Indiana?
A person is not entitled to this deduction unless the Pt Z q l S w y p (.J 'ebtedness that is recorded in the county
recorder's office(including any home equity line of ca t basis for the deduction.
ao1(.,- \-1 y -2 lc
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
owner/contract buyer of the aforementioned property on date application is filed.
Si nalure ov eels furl ndame AAII , (.y /(�`� Date(month,day,year)
g Y.L /�(TU.! JY1 l A l t/ ��`
Fuff resid address,o{applicant(number and s t city,s ate, d ZIP code)
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 S10,000.