HomeMy WebLinkAboutMortgage_Mid West Dev to STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�:: FOR DEDUCTION FROM ASSESSED VALUATION
'1. State Font 43709(R13/10-15)
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Presed by Department of Local Government Finance
To in pars $ '
To be filed in person or by mail.
1 Frfng Dates 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or pasbnarked with the County Auditor or County Recorder of the county where the property is County Auditor
located on or before January 5 of the immediately succeeding calendar year .I 8 II''jj,,gig unty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the coun4U L `Z L 18
where the property is located during the twelve(12)months before Mardi 31 of each year the deduction is sought
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See reverse side for additional instructions and qualifications.
Applicant(owner or contra C�b�yrt reverse side) `,N� -----
If ly \11 GIBBON COUNTY AUDITOR
Taxing District Key number/legal descri Record n tuber number
Sri 1 4a-2014-tba -Si Li—Da29 r� �J�S
Assessed value of real property as of rtgage I Contract Indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applint sole
assessment date,amen year essment date,current year a of application legal or equitable owner?
r I 6,00 ❑ 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 nn .Is the property in question:Annually Assessed
1-A414,1- ,/� -fit 1 /I ❑ Real Property ❑ AnnuelHA a(IC 6
Il��l Mobile Home(IC 1x11-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street city state,and ZIP code)
Name of assignee or other owner or holder of mong— ( -
Address of assignee(number and street oily,state, Ma 0 \ `a- ���t`r % �_t-k(o
Does applicant own property in any If yes,what a ` `\ W\\C CA ` �J e`�f O e�C n requested If yes,state imam of deduction
other in Indiana? ❑Yes 0 N -Ix.9_ <c V vs\ \-lC&1e v.�.� (es 0 N _
A person is not entitled to this deduction unless \\ I, act indebtedness that is recorded in the county
recorder's office(including any home equity lin QC,.r�c \S, Cab v , D U t 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,yea)
I I We certify under the penally 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 fur/name) l _' - "Date(month,day,year)
WI resident address of appfxant(number and street shy state,and ZIP code)
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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.