HomeMy WebLinkAboutMortgage_Gilbert STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
'tl', FOR DEDUCTION FROM ASSESSED VALUATION
•'• State Form 43709(R13 t 10-15)•W Prescribed by DepartriteM of Local Government Finance ;
INSTRUCTIONS: ' it Ma ! .S
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 J r
•Must be Ned orpostmarlced with the County Auditor or County Recorder of the county w U here the property is r:.•�•Iry Auditor
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 County Recorder
where the property is located during the twelve(12)months before Mardi 31 of each year the deduction is sough¢ , ./,��•
See reverse side for additional instructions and qualifications. • • •
Applicant - or contract buyer-see restrictions on reverge side)•
Taxing District J
IX de l(J log - aoo, 4 si-o a 8 Record°/ 10r p U U 7
Assessed value of real property as of CX Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment dr CUIMrd yeat date of apgip'uon legal or equitable owner?
(oy (/�x(JCj/� ❑ Yes ❑ No
tf 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 belay. Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
•
• Mobile Home(IC 6-11-7)
Name of mortgagee or contract seller 5/3
Address of mortgagee or contract seller(number and street city slat GL-7_ 66.
Name of assignee or other owner or holder of'wag age ,
G EbpC-,Cl
Address of assignee(number and street,dry,state,and ZIP code) /}� .�7,n
Coes applicant own property in any If yes,what county? I 'j2 LL~`O� cl If yes,state amount of deduction
otter county
.Indiana? ❑Yes ❑No I -a 8 to
A person is not entitled to this deduction unless the person h: tdness that is recorded in the county
re=aders office(including any home equity Fine of credit that is recorded in the county recorder's office)that is the basis for the deduction.
_ COUNTY AUDITOR
Dniuction 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
ownei/contra• b -r of e - • - •ned property on date application is flied.Y.. --(77( /
—gnaw atu .. .� L l� 7 a S--Ib
rnm
resident fant(number state. code)
I applicant
l S
k r, ? n
Prison authorized by duly executed Power of Attorney or by IC 6-1.7-12-0.7 Date(month,day,year)
Address of authorized person (number and street thy,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.
•