HomeMy WebLinkAboutMortgage_Kelley STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
f 44.c.1.1, FOR DEDUCTION FROM ASSESSED VALUATION
'^ State Form 43709(R13/10-15)
-^ Presrrtbed by Department of Local Government Finance �e , g
INSTRUCTIONS: g I J Fi i s � :
lb be filed in person or by mail I i. 1,
Filing Dates 1) Real Property:Must be completed and dated in the calendar year for wind]the deduction is sought
Must be filed orposbnarked with the County Auditor or County Recorder of the county where the props s County Auditor
located on or before January 5 of the immediately succeeding calendar year. JUL
5
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 Mardi 31 of each year the deduction is�ough
See reverse side for additional instructions and qualifications. P 4
Applicant(
cagyvir
or contract buyer-see on reverse side) GIBSONCOUNTYAUDITOR
T�'n�gatriG / number/ description Record number Page number
'—j%t1t 4S►✓ d -la - o8 - 104/- 00i_ tyr9- a .- 8 ?o/ io -I 3 ?
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment data,amend year assessment date,cement year date of application legal or equitable owner?
gY/000 ❑ Yes ❑ No
If rm,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 belw... Is the property in question:Annually Assessed
❑ Real Property ❑ AnnuallyAssessed
• Mobile Home(IC 6-11-7)
Name of mortgagee or contract seller
F C U .
Address of mortgagee or contract seller(number and sheet city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage ,
Address o gnee(number and street city,state,andjlP code)
Does ;cant own property in any If yes,what county? What Taxing District? Has thi (I`L1
other county Indiana? ❑Yes ❑No w C.Z UK- Z Ti 1 ,b° C-)
in A person is not entitled to this deduction unless the person has a balance on the person's mods /
recorder's office(including any home equity line of credit that is recorded in the county recorder ao k L - \a-3 a 4-4 b
•
COUNTY AUDITOR
Deduction approved in the amount of
20_ 20 20 20 20 20 20
Signature of CountyAuditor County - Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned roperty on date application is filed.
xSignanur (oo�wnneer'swha name Data(month,day,year)
Full resident, a let of (number d and Ttttu x nnd ) w Person authorized by duty execut Power of Attorney or by IC 61.1 Date(month,day,year)of authorized person (number and sheet cry,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. .