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HomeMy WebLinkAboutMortgage_Loyd (2) .1 a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year FOR DEDUCTION FROM ASSESSED VALUATION State Form 43709(R t 3/1 615) I Prescribed by Department of Local Government Finance INSTRUCTIONS: g$ I" TO be filed in person or by mail. g .It,i led with: Filing Dates 1) Real Properly Must be completed and dated in the calendar year for which the deduction i g Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑ County Auditor located on or before January 5 of the immediately succeeding calendar year. 4IIf, 1 201I ❑ County Recorder 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the Eo6 where the property is boated during the twelve(12)months before Mardi 31 of each year the deduction is sought See reverse side for additional instructions and qualifications. I • i Applicant IA er• contract byu�yer-see restrictions on reverse side) r ter'l7 r• -WJ' 1, ' t ' \ 4- �Jtta J 4 GIBSON COUNTY AUDITOR Taxing D., . /` -1 a � r 400-00a- f 3`i-Dos" Record%� iDd Assessed value of real property as of OC�O Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole assessment data,current year asses n[©das,current year date of application legal or equitable owneR L'�J o llt�C7J, ❑ Yes ❑ No If no,what is his 1 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 ❑ AnnuallyAssessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller n /I 7 o t) 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 cry,state,and ZIP code) Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction in�IMiana? ❑Yes ID No aaiinenpro Wir?for ❑Yes El No 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 Signature of County Auditor County • Data(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. Signatu - • - friH name / Date(month,day,year) F _'J�of applicant(number d street city state,and LP code) 2271 Stn . 14 -era ALL) it), K7la 41 P n authorized by dory executed Power of Attorney or by IC 61.1-12-0.7 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. •