HomeMy WebLinkAboutMortgage_Gatewood (2) „> STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
f—<—'' FOR DEDUCTION FROM ASSESSED VALUATION
�' State Form 43709(R13/10-15)
Presalbed by Department of Local Government Finance L
INSTRUCTIONS: File Mark
lb be filed in person or by mail. S re,, ywr),r
Filing Dates 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought
Must be bled 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.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the p(�f(0pjjyy__�� Winn.
ecorder
where the property is located during the twelve(12)months before March 31 of each year the deduction 73'IBc3�NEV : . • - • I a IT OR
See reverse side for additional instructions and qualifications.
Appfua orconoad buyer- mbe side)
Record nimtir T , .'..- �t0 • / /� .307+ QO/- o$`007 916/tP rJe/ O�
Assessed value, illy as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contra ebtedness unpaid as of Is the applicant the sole
assessment date,etus year assessment date,current year date of appl�u/�,(rp p legal or equitable owner?
CY / 9dO1a
0 Yes 0 No
If no,what is his I her exact sham of interest? If owned with someone other than spouse,indicate with whom
If name on record is dw°erent than that of augment,indicate below. Ls the property in question:Annually Assessed
[ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Fie/r) Alir-nie
Address of mortgagee or contract seller(nu street ray,state.and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city 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
other county „ property for
in Indiana? Yes ❑No current year? ❑Yes ❑No
.4 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(incfudmg any home equity fine 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 I 20 '20- 20_ 20 20 20
�J(Zf
Signature of County Au , I_ _ — County • Date(month,day,year)
•I��.
1/We certify and ^ M abon is true and cored and that the applicant is a resident of Indiana and
owner/contract I (W— 3 r7cLA is filed.
( ” Signature hr Date(month,day,year)
Full r addres_ O /�,,, // 0 O
(7j r oX. ._ kVX_ 7` ?l0(D
Person authorized by duty executed Power of Attorney or by IC o-i.,-.- > Date(month,day,year)
Address of authorized person (number and street dly,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.