HomeMy WebLinkAboutMortgage_Livermore (2) c s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
Cif FOR DEDUCTION FROM ASSESSED VALUATION
'-_ State Form 43709(R13/10-15)
S` ., Prescribed by Department of Local Government Finance
INSTRUCTIONS: F I i1) File Mark
75 be filed in person or by mail. Form filed with:
Firing Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought
Must be filed orposimadced with the County Auditor or County Recorder of th cagy lff the property is County Auditor
located on or before January 5 of the immediately succeeding calendar yebY
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 befom Mandy 31'1yeach year t�tp'.dedudion is sought
See reverse -•e for additional instructions end qualifications. •�
Applicant(W•erw••(•buyer a•'-%•,r on.reve - -) GIBSON COUNTY AUDITOR •
IT /legal desaipVon Record number Page number
�' 1cPodU� d6—ia-onJV-cxE-ooi .6io-0:): 0.-0I(0 a9ra/
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment d aneennttyyear date of apprxation legal or equitab,'e owner?
O1O0C ❑ Yes ❑ No
If no,what is his/her exact sham of interest? If owned with someone other than spouse,indicate with whom
If name on record S(Efferent than that of applicant,indicate below. Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6r1.1-7)
Warne of mortgage o seller
PG.,--iiicie voi„ciy,
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Kan'—.-_-O•-,•.Mmr or holder of mortgage
f•c
[a Drawer N 0.a ly Waal Taxing District? Has on thisdeeduction been requested If yes,state amount of deduction
on
in argent year? ❑Yes ❑No
A o N as a balance on the person's mortgage or contract indebtedness that is recorded in the county
re: Card O. I `•�• t is recorded in the county recorders office)that is the basis for the deduction.
_ COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Si of Cou Auditor Court 1 Date momh,/�d1yj /
y A /. -Jr,� y � ( v'/ O1 In-/
I I We certify under the r-natty of pe-ury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
, owner,/contract b - of the a tioned property on date application is filed.
Date(month,day,Yom)
t\KiF(}[
•esddenem ad•• • t(number and street aly,state,end ZIP code)
J
Person a •. •• _• by duly executed Power of Attorney or by IC 61.1-124.7 Date(month,day,year)
Address of authorized person (number and street cats 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. _