HomeMy WebLinkAboutMortgage_Merry a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou •' _' +I1; Year
itf- r. FOR DEDUCTION FROM ASSESSED VALUATION �r
,•-•,! i' State Form 43709(R13/-10.15) ,
�- Presalbed by Department of Local Government Finance ;(q�
INSTRUCTIONS: t U "' (6
To be filed in person or by mail. Fo fit
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 property i n Apuditor
located on or before January 5 of the immediately succeeding calendar year. GIBSON COL CouDryTKemrder
2) Mobile/Manufactured Homes not assessed as Real Property:Must Me with the County Auditor of the county
where the property is located during the twelve(12)months before Mardi 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or conbact buyer-see • -.•.• -rse side)
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Taxing District .... /legal description Record number Page number
SL4 )i - la- U - Dn - as S8'1 -act / 69 3v3Co
Assessed value of real properly as of I Mortgage I Contract indebtedness unpaid as of 1gage I Contract indebtedness unpaid as of Is t e applicant the sole
assessment date,cement year assessment dare,current year ate of application legal or equitable owner?
k �- ram [i 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 I{theme prloperty in question:Annually Assessed
• Property ❑ Mobile HAssessed
me(IC 61.1-7)
Name of coo or contract seller
AddLmint mortgagee orzaractjr1grTiumber and street city,state,and ZIP code) -- -
Name of assignee or other owner or holder of mortgage D j
a11'et- NO ( n
Address of assignee(number and street oily state,and ZIP code)
Caro No. •
Does applicant own property in any If yes,what county? IMmt Taxing District? Ha '' ion
other county on �` •., ,
in Indiana? ❑Yes ❑No .arts u ! /I n I ((��' t�
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract incer —L�l OSwc (C c-, 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 deduccu'.._
COUNTY AUDITOR •
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 1 contract buyer of the aforementioned property on date application is filed.
�re( name) Date(month,day,year)
resident address of applicant(number and street,rely state,and ZIP code)
l 399 ( f SO t\l• 9-:&Lttkor. j tN) HO 670
authorized by duly executed Power of 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 owde)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.