HomeMy WebLinkAboutMortgage_Rahman (2) .. , . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
•�f a FOR DEDUCTION FROM ASSESSED VALUATION
i;= '�:` State Forth 43709(R13/10-15) IL:j
Prescribed by Department of Local Government Finance p�AA�r�,/// "�4 )
INSTRUCTIONS:
To be filed in person or by mail. Form filed with:
Filing Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sougtOr
' Must be filed or postmarked with the County Auditor or County Recorder of the county whem the Idrrbb Pith;
2016 ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year ❑ Courtly Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor o e noun
where the property is located during the twelve(12)months before March 31 of each year the '
See reve -= '.e for additional instructions a p aiifcations. GIBSON COUNTY AUDITOR App • - or con d• - � /; .
T. - BS lrt Key • -1 D legal�es cdD/ 4 003 ..1--,O/7 numbo er
0 7/
>•value of real p as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date, assessment date,arrant year date of legal or equitable owner?
�� / V ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with Bone other than�,indicate with whom
If name on record is afferent than that of applicant,indicate below. ,Iss the property in question:Annually Assessed
(y Real Property ❑ Annually Assessed
11 Mobile Home(IC G7.1-7)
Name of mortgagee or contract seller /
/ C
Address of mortgagee or contact seer(nu street city state. LP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code) /'j
Does applicant own property in any If / - /-/O Oat• �/� �al
other county yes,what county? What Taxing District? on Has is de for ction been requested If yes,state amount of deduction
in Indiana? ❑Yes ❑No cement year? ❑Yes ❑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 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 I contract buyer of the aforementioned property on date application is filed.
gignatu - - roll name) Date(month,day
47(42P 6
( F .1 resident ad.._ of- t(number and street dry,slate,and ZIP code)
11` 17o3 Ai. S1, c R...d er /i..*C74) ..2-X/ K76"KO
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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.