HomeMy WebLinkAboutMortgage_Przymus (2) •°'t,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
< FOR DEDUCTION FROM ASSESSED VALUATION
• ' �il State Form 43709(R12l 6-14)
'';;wit Prescribed by Department of Local Government Finance
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• INSTRUCTIONS: IF M43
To be filed in person or by mail. F I r
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 property is ❑A� County Auditor
located on or before January 5 of the immediately succeeding calendar year. JUN (2]2UiNnty 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 sou t.
See reverse side for additional instructions and qualifications.
rApplicant(owner or con(rac�buyer-s s ' 'ons on rev side) GIB$ON COUNTY AUDITOR
Taxing District Key number/legal desaipti Reoard umber Page number
6 — r■lei - to - • 3c1- oag is /13? .
Assessed value of real property as of gage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year ch current year •- date of application legal or equitable owner?
�.Sj� • El 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 A«• ed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller Q
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 and street,&y state,and rrZIPZ
Does applicant ovm property in any If yes,what r .I/ I `�7 Mils I P� len requested If yes,state amount of deduction
other county TT 1 ES L
inlndiana? ❑ ,W Yes ONO FRAki 'es 0 N
A person is not entitled to this deduction unless 1 act indebtedness that is recorded in the county
recorder's office(including any home equity ling l V 193 R is the basis for the deduction.
Deduction approved in the amount of: 1
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.
re(27ename) Date(month,day,year)
t add of nt(n -'0 and. ret,city, ate,and ZIP col 2 7
Person authorized by duly executed Power of Attorney or by I r 1.1-12-0.7 -`V\ �'f/f 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$10,000.