HomeMy WebLinkAboutMortgage_Davis (10) � . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
e^. :,;^ FOR DEDUCTION FROM ASSESSED VALUATION
�'^ Slate Form 43709 par/10.15) (
�- Prescribed by Department of Local Government Finance
INSTRUCTIONS:
To be filed in person or by malt Form filed with:
Filing Dates' 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought S E P b in I R Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is
located on or before January 5 of the immediately succeeding calendar year. ❑ Court Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county 7)/
where the properly is located during the twelve(12)months before March 31 of each year the deduction is so ..--
See reverse side additional instructions and qualifications. GIBSON COUNTY AUDITOR
Applicant(owner read buyer-see% verse side)
Taxing District I7-r� d 6 -400- o 1• I I 'r+ oat R inpber PacTritnyc2
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessmenetteriurrent yea date of application legal or equitable owner?
❑ Yes ❑ No
If ro,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is d ferent than that of applicant,indicate belwr. Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller SI 3
Address of mortgagee or contact 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 at state,and ZIP code) ((�� /},(/'
Does applicant own property in any If yes,what county? What Taxing t'� �u . ate amount of deduction
other min -\ 5 J
oilier
Indiana? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance s recorded in the county
recorder's office(including any home equity fore of credit that is recorded, X 1 - I O 0 • O U ruction.
COUry r T 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/contract buyer of the aforementioned property on date application is filed.
�tgOa ur (at7rees flail name) —� DateJigonth,dry,yepr)
�]4� (.71/ �L�J . .L )em.,csc.c_� C,I/ rfl �1/i
P asaiftd app t tuber and dry, te.and ZlP�oge q ) 3 at
authonzed duty executed Power of Attorney or by IC 6-1.1-122-t7` ' Date(month,day.year)
Address of authorized person (number and street 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. .