HomeMy WebLinkAboutMortgage_Saunders Eu .y-. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15) y g�
Prescribed by Department of Local Government Finance 9 ` tl 9 ' p A
INSTRUCTIONS: 1B ` J®le gtl-/tl
To be filed in person or by malt 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 Audrtor or County Recorder of the county wham the property is J�'LEI ditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county n �untyReco er
where the properly is located during the twelve(12)months before Mardi 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Applicant(o or contract buyer-see restriction on verse side)
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Twithg El ` number/legal description Record number Page number
D/0 — 0-- 1 ( — 30 —00 l. 3$?-00 4 ! Pr-)63
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 date,current year assessment date,current date of application legal or equitable owner?
Ia ❑ 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,initiate below. Is the property in question:Annually Assessed
e.... • - nv 0 Real Property ❑ AnnuallyAssessed
Mobile
Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street city,state,and ZIP code) -
S/1U� D�12S Sad^Cs G
Name of assignee or other owner or holder of mortgage A- f
Address of assignee(number and street city,state,and ZIP a Kl�)ar�if I,, rr
o�applicant own property in any If yes,what county? /6 -aa1 to J ed If yes,state amount of deduction
in Indiana? ❑Yes ❑No (O _ .__ No
A person is not entitled to this deduction unless the perm.,„aa a valance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's 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.
rue V) /\ Date(month,day,year)
Full address of applicant(number and sheet aly, and ZIP code)P' .ten Ste. Li .7 ( yq
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$10,000. .