HomeMy WebLinkAboutMortgage_Williamson (6) .oa. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
'f'= t FOR DEDUCTION FROM ASSESSED VALUATION
" �'` State Form 43709(R131 10-15)
t Prescribed by Department of Local Government Finance
INSTRUCTIONS:
I
lb be filed in person or by mail rrm n
Filing Dates 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought ❑ Court Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is county
located on or before January 5 of the immediately s ' calendar year. S' c�o p,Rarnrder
2) Mobile/Manufactured Homes not assessed as Rea/Prope :Must file with the County Auditor of the county 0 tU
where the property is located during the twelve(12)months fore March 31 of each year the deduction is sought n
See reverse - for additional instructions and•••-•fixations. �-T -1,1.r_
Appgan (. or contract foyer-see resvicaonsverse side) 0 9
GIBSON C
fir
• -ee. J� //�Iry Ana OUNTYAUDITOR
•..• Keys I atdesai L(�Yn number enum
. , -� 53‘ o aO. 4477-00 9 G/� `Cr9
Assessed value of real property as of Mortgage I Contact indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assess-nerd dap,amen year assessment dap,current year date of applica to m+ legal or equitable owner?
/ 7 ❑ Yes ❑ NO
If no,what is his I her exact share of interest? If owned with someone other than spouse,radiate with whom
If name on record is different than that of applicant,indicate below. Is t[�property in question:Annually Assessed
Real Property ❑ Annually Assessed
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Mobile Home(IC 6-1.1-7)
Name otrxoA9ageeaauitract seller //( / ' / /
Address of mortgagee or contract seller(number�street •• Pt•e)
Name of assignee or other owner or holder of mortgage !!l111
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Address of assignee(number and streak c+ry,state,and ZIP code) / l /� 4(7/ /)
/�J �w1CJ� �•(/O ..3— // � 6OV
Does applicant own property in any If yes,what county? Wnat Taxing District? Has this deduction been requested If yes,state amount of deduction
in Indiana? ❑Yes ❑No on�? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contact indebtedness that is recorded in the county
recorder's office(induding 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
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Signature of County Auditor County Date(month,day,year)
/1 is 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
j(Y owner/contract buyer of the aforementioned property on date application is filed.
-*Sg� ature(ownsrs tuff naame)e)) ' Date(month,day,year)
7 yg Full resident address of applicant(nmn . and ee.1,city,state.and ZIP code)
/DP S. L✓¢6-r f/i; /4'44s4 6 74 4/77 39
Person 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 code)
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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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