HomeMy WebLinkAboutMortgage_Menke (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CyyTypms� Year
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FOR DEDUCTION FROM ASSESSED VALUATION JL 1 @-1
Siate FOini 43709(R73/70.15) a
Prescribed by DeparbneM of Local GovemmeM Finance
INSTRUCTIONS: S E P 1FEte 1
To be flied 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 sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the proper County Auditor
located on or before January 5 of the immediately succeeding calendar year. GIBSON COUNTY 9444 ecerder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twehe(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side) ( — 1/�'
—1 ` t SL A) 3 L, x- Qy 2., j) l9— S TIC )-4X--cet t-r�
T strict hey nu legal description Record number Page number
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value of rent property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
mant date,current year assessment date,current year date of application legal or uitable owner?
tn1.2,/L` O I5 ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is deferent than that of applicant,indicate below-. ,I_s itheeppropely in question:Annually Assessed
Properly ❑ AnnuallyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
CT fir . tQ
Address of mortgagee or contract seller(number and street city state,and ZIP code)
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(�\OIvsA v"tvct-Q
Name of assignee or other owner or holder of mortgage _l W U
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Address of assignee(number and sheet,city,state,and ZIP code) � �c
av\� S 1 G-a�" �o
Does applicant own property in any If yes,what county? What Taxing District? Has t \ t t O U b U n
other county �� p., onpn
in Indiana? ❑Yes Rib , artei
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 ot.
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.
signature(owner's lull name) Date(month,day,year)
\�Z A . . 9-/ 9 -.20/
'Funrl faant(number and street city,state,and ZIP/code)
Y /294 ( 5. `t e a" n.ste.t ilk. /Mc sfo,cl-I- /N 40639
P�authorized by duty exear Power of Attorney or by IC 6-1.1-12.0.7 r 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.