HomeMy WebLinkAboutMortgage_Doty (2) } STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
'f' ,'','_ FOR DEDUCTION FROM ASSESSED VALUATION
It State Form 43709(R131 10-15)
S"M=4' Prescribed by Department of Local Government France
INSTRUCTIONS: f A
To be filed in person or by mail. inn filed with:
Filing Dalos 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought �r(
Must be filed or postmarked with the County Auditor or County Recorder of the county whom the property is JUN 1 1 �1 Auditor
located on or before January 5 of the immediately succeeding calendar year. LJ
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county' County Recorder
where the property is located during the twelve(12)months before March 3 • each year the deduction is so ., • wry
See reverse - for additional instructions and qualifications. . • -i/'m/rt
Applicant(. cants a• •• >. -see - •on reverse side) / / / • / GIBSON UUUN I Y AUDITOR
� �l� i/ �!a.—L-. 0 � / a / Z 4 -
Taxdng / T u /legal description Record number Page umber
,d$is-o 27607- 4007,,-193 - 007 P7 I 0 Q1C,)b
Assessed value of real property as of Mortgage/Conrad indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appliant the sole
assessment data,current year assessment date,current year date of application _ legal or equitable owner?
9Q4(17 ' ❑ 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 contract seller
Address of mortgagee or contract seller(nu be,and-•-e. •• te, ZIP code) J
Name of assignee or other ovmer or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other in county prn� ❑ana? ❑Yes El No current year? Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorders office(including any home equity line of credit that is recorded in the 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)
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.
Signature rD nampy J Date(month,day,year)
Full resident address sof�/a{p6mn/ t(number and street,al%state,and LP code) -
j. (611 N. 1-4.,{1- SI, �'/✓rz14vYr '/76 70
I 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)
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The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.
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