HomeMy WebLinkAboutMortgage_Rexing c a. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
i• , FOR DEDUCTION FROM ASSESSED VALUATION
,' �'. State Form 43709(R13/10-15)
S / Presa bed by Department of Local Government Finance -
lob7RUCTn person IF IL d M r
To be filed in person or by mail o .Lyy]
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 Auditor or County Recorder of the county where the pope fly h ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. JUL 2 7 2 1t
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county W_I County Recorder
where the pal instructions is located during the ions. (12)months before March 31 of each year the deductio is sough
See reverse side for additional insWctons and qualifications. A
Applicant(owner orcontr ad buyer-see restrictions on reverse side)
4) GIBBON COUNTY AUDITOR
T District Key number/legal tlescription ' 0 Record number Page number
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a (0- A3 -t8 - Soo - coo. 8s , - oa c 0.0 (4, � w
value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedn unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
1 C/ g a-O 0 ❑ Yes ❑ No
0 r ,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. Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
• Mobile Home(IC 6-11-7)
Name of mortgagee or contract seller ` n/l/�
Address of mortgagee or contract seller(number and street city,state,and ZIP code))
Name of assignee or or owner or holder of mortgage - -
Add of assignee(number and street dry,state,and ZIP code) C �- C�e S e N
% sw le - Li -!o , -7 5 c Rte,( ^ \F{ 11
Does applicant own property in any If yes,what county? What Taxing District? Has this dad S� `` —V.�S 1
other
Indiana?county ❑Yes ❑No current year \ t�e- 4A� ccclll...
A n is not entitled to this deduction unless the t I (h a I U coo`L - (-1\() —
person person has a balance on the person's mortgage i l U V U (I 1 l
reoorders office(including any home equity line of credit that is recorded in the county recorder's o...__, 1 lo-(c
COUNTY AUDITOR
D ubon 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.
1 Sigpature(• ; s tun name) ^ Date(month,day,year
Fr a resident address of-•.•..- t(n her and ii - city,state, - •ZIP code)
)e- 12 o v1 . 1. r • ■ -1-I • _
Person authorized by duly executed Power of Attorney or by IC 8-1.1-12-0.7 Date(month,day,year
Address of authorized person (number and sheet city,state,and ZIP aide)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. .