Mortgage_Bobbitt STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
1.aar County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
11,:.,1:‘� �� State Form 43709(R13/10-15) - -
1 .i. Prescribed by Department of Local Government Finance
INSTRUCTIONS: F I I Ile D
To be filed in person or by mail. Form filed with:
Filing Dates 1) Real Properly.Must be completed and dated in the calendar year for which the deduction is sought 41 ((;;
Must be filed orposfmadced with the County Auditor or County Recorder of the county where the pruj lr)tyisi 2l]I L] County 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 ...wily , County Recorder
where the property is located during the twelve(12)months before March 31 of each year the deducti. 1.'• ';0 runner
See reverse side for additional instructions and qualifications. GIBSON COUNTY Al IflITQP
Applca, ow�ne'ror, contact -r- --� - .�,..on reverse side)
o
T- ..D.• Key number/legal desaiptm Record n r Page number
/ , t9 -ur•-- o�(r, - 09_ dq - 3°3_0oo . 33 ,2 _oat 4b I 3615
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortg a Contact ebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of a legal or equitable owner?
980 0 ❑ Yes 0 N
If re,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom '
li name on record is ddferent than that of appfant,indicate below. Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Horne(IC 6-1.1-7)
Name of mortgagee amtract seller `
Gam-/,dn.-r,,..e,d 1 e2.. 7 LO 4
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street try,state,and ZIP code)
pother applicant awn property in any If yes,what county? What Taxing Di `�Q ,state amount of deduction
in Indiana? ❑Yes 0 No 1 Drawer 1r0,,,,;•.t-C person is not entitled to this deduction unless the •••.••••••.at is recorded in the county
recorder's person has a balance c
corder's ofice(including any home equity line of credit that is recorded ii deduction.
CO1i Card NO. ...... ., ,
Deduction approved in the amount of
•
20 20 20 2l � 20
Signature of County Auditor Crnmty 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
• -ct buyer of the afo -me •ned property on date application is feed.
5:. t\ r Date(month,day,yea/)
Full resident address of applicant(number and sheet,city,state,and L.code) ,
Person authorized by duty executed Power of Atom r 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$10,000.
•
is-$ ----n—�--