HomeMy WebLinkAboutMortgage_Oliver STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
°- a FOR DEDUCTION FROM ASSESSED VALUATION
=''ry�x State Form 43709(R13110.15)
Y Prescribed by Department of Local Government Finance •---
INSTRUCTIONS:
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To be filed in person or by mail. 'Fomh filed with:
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 CountyAuddor or County Recorder of the county where the properly is SE' 9 C$g3'Auditor
located on or before January 5 of the immediately succeeding calendar year. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the dy is located during the twelve(12)months before March 31 of each year the deduction is sought ,
See reverse side for additio sbuctions and qualifications. _omit
AppSnnt(ownercroon/tact ms(w' 'onsonre de side ^ GIBSON COUNTY AUDITOR
Taxing District Alb- /a-1 J yic.•+.Jno � VIJ�.J – ( 1 1 -0d6 Record number Page number
O
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,airiest year assessment rrent date of application legal or equitable owner?
at 000 yes 0 N
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 different than that of applicant,indicate below-.. Is the property in question:Annually Assessed
❑ Real Property ❑ AnnuafyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
.5 13
Address of mortgagee or contract seller(number and street city,state,and ZIP -- — -
Name of assignee or other owner or holder of mortgage (R1.ai 1-1-A i D Q(- LV -Oa
Address of assignee(number and street city,state,and ZIP code)
I (� - 33c0
other applicant own property in any If yes,what county? What Ter: es,state amount of deduction
in Indiana? ❑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 informations true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of theraforementioned property on date application is filed.
Signature(• NO name) Dale(month,day,year)
1
Fri ..• of ap &an num ?Jr• state,an t ode)501 A
14 76 Yf
Person authorized by duty 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.
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