HomeMy WebLinkAboutMortgage_Delong (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
Pr. FOR DEDUCTION FROM ASSESSED VALUATION
*' State Form 43709(R13/10-15)
- Prescribed by Department of Local Government Finance
INSTRUCTIONS: tle Vail(
lb be filed in person or by mail. F rrr filed wrtrfl
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought A� 1V
Must be filed or postmarked with the County Author or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. G [�O�unty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the coup!.t 1
where the property is located during the twelve 02)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and quaffications.
Appfxan/(°�'�er connect bu see0``� -verse side)
l/ ct � ' �, GIBSON COUNTY AUDITOR
Tall9g District Key nu .- /legal.--.'.t.. Record n e numbs
i� - a - ire -t8 - /03 - .5 )D -o fs 1 Ohl'
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year / date of application legal or equitable owner?
7 (p/ C7(� r tl ❑ 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 appricant,indicate below Is the property in question:Annually Assessed
❑ Real Property ❑ AnnuallyAssessed
• Mobile Hone(IC 6-1.1-7)
Name of mortgagee or contract seller 1/4A-4--
Address of mortgagee or contract setter(number and =state,and ZIP code) _ 1r�_1L' _ --G, r-y� 11
Name of assignee or other owner or holder of mortgage '-"-L V�G r �nw5111'�h 1+ L
Address of assignee(number d 54eet city,state,and ZIP code) I`0 -A "c S
ham, Haar' FiCC/V✓L. / 9 / fi1?4?9'
Does applicant own property in any If yes,what county? What Taxing District? Has $.77 t0� 4 0 CO /n/l f/g4.644__�th
in Indiana? ❑Yes ❑No Curren �Ka( �
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
e$Signature of County Auditor County Date(month,day,year)
:,... I/We certify under the penalty of perjury that the above and foregoing information is We and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is fled.
Signatu full Date(month,day,year)
k)(CU- !/��/� /may
pis
of appEcannt(m7t6er and street,coy,state,and ZIP code)
/32_ 9 c Viin; / 131,,,/ Prio ,.764 Z A/ 4.7170
Person authorized by duly executed PwrePof Attorney or 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.
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