HomeMy WebLinkAboutMortgage_Douglas (4) �a�. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
S r;=e'' FOR DEDUCTION FROM ASSESSED VALUATION
I!' ? State Form 43709(R13/10-15)
b , Presatbed by Department of Local Government Finance
INSTRUCTIONS:
F ii I
To be filed in person or by mail. Form filed with:
Fling Dates 1) Real Properly.Must be completed and dated in the calendar year for which the deduction is sought
UL 2 ?dunty Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property r
located on or before January 5 of the immediately succeeding calendar year ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the cou
where the property is located during the twelve(12)months before March 31 of each year the deduction is
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
m(owneror compact buyer- restrictions on reverse )
/N/ UD TOR
Taxing District ,Y/ Key number/legal description Record number Page number
a" • • ' a6 - /7- OS - 900 - D00 • 9118 - od / /lam ash
Assessed of real•,•.•J as of Mortgage/Contact indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole •
assessment•• •• avert - assessment date,current year date of application legal or equitab,'e owner?
7 . 000 ❑ Yes El No
If rho,what is his I her exact sham 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
S. B .
Address of mortgagee or contact seller(number and street city,state,and ZIP code) U AA
Name of assignee or other carnet or holder of mortgage V�(,f �,I.IS, JOJIU- (�
Address of assignee(number and street city,state,and ZIP code) PE_,r�Cc n F�
PT sE spc S- .3 -/ x 3.334 c c _
other applicant own property in any If yes,what county? What Taxing District? Has property dedu 1/ ) a
in Indiana? ❑Yes ❑No current year? IP of
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or conuau-...__ :y
reorders office(including any home equity line of credit that is recorded in the county recorders office)that is the basis for true w,._.
' 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.
kSi---n• e rits full name) / Date(month,day,year)
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XiFurl •ent address of applicant(num d •-4 city,sta-,and ZIP code)
. 1k_. , . 1 t I1P / I • . / 41 7t%Z5
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Data(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. .