HomeMy WebLinkAboutMortgage_Fryman ,fici. .. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
_e FOR DEDUCTION FROM ASSESSED VALUATION
1! �' State Form 43709(R13/10-15)
Prescribed by Department of Local Government Finance 7
To beRUd in pens F f t
IN be filed in person or by mail Fu led
Filing Dates 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought rt
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is 0 County Auditor
located on or before January 5 of the immediately succeeding calendar year. J U L `A 88d6ty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
whom the property is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and quaTications. l�ter'•�.(f-�
owner or contract buyer-see inverse side1 �}q�
r c e nil/ �44� M GIBBON COUNTY AUDITOR
Taring District Kett ny-a 3 l goo-Co.2 -1 '1 V'£ 4 Recrord P r 3 number 7 f ry
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid`aas of Is the applicant the sole
assessment data,current year assessment date,current year date of application legal or equitable owner?
3 Alt f ❑ Yes ❑ No
If 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 below. Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-11-7)
Name of mortgagee or contract seller
al
Address of mortgagee or contact seller(number and street city,state,and ZIP code) -
-
Name of assignee or other weer or holder of mortgage -—
Address of assignee(number and street city,state,al_,,_.c -
Does applicant own property in any If yes,what cou. • 020/// been requested If yes,state amount of deduction
other county 1 Y.. W.
in Indiana? ❑Yes 0 N D)-a\\'Cl' 1�••""/•-�' •• IYes 0 N
A person is not entitled to this deduction unless U. • 1 /q/ tract indebtedness that is recorded in the county
recorder's office(including any home equity line c ir9 1( .•, • at is the basis for the deduction.
Card NO. .............
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 rrr/contract buyer of the aforementioned property on date application is filed.
Sg�yre( one}, _r Gate(maim,day.year)jud
residentad applicant(number and sheet plz slate,and ZIP code) 1 ,
yocoa LE ✓ Va & Ra..A- 4 4205
Person authorized by duly executed Power of met or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet city,slate,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.