HomeMy WebLinkAboutMortgage_Hupp STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
•. ; FOR DEDUCTION FROM ASSESSED VALUATION
<:, State Form 43709(R13/10-15) 17 g
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Presed by Department of Local Government Finance p ' LIME, D
INSTRUCTIONS: g
To be filed in person or by mail. Form filed with:
Fling Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought S E P 2ra Zafty Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly is
located on or before January 5 of the immediately succeeds g calendar year. Co ty Recorder
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county •
where the properly is located during the twelve(12)months before March 31 of each year the deduction is sou
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
••,��. .. ,.ct buyer- ;.. on reverse-I I le
r 1 •
Taxing District / 0 -Jumber II d i
^ 6 _ Vtioo—cw6b Y-102( /`r• Page number/
Assessed yak*of real property as of Mortgage!Contract
indebtedness unpaid as of Mortgage!Contract Indebtedness unpaid as of Is the applicant the sole
assessment date,cement year assessment date,current year date of ap ..rt legal or equitable owner?
!� ❑ Yes ❑ No MO
If no,what is his!her exact share of interest? I R owned with someone Miter than spouse,indicate with whom
tt name on record is different than that of appriraurt,ind' betas Is th property in question:Annually Assessed
Is
Property ❑ AnnualyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller �� (�//�-/�////-//��
Address of mortgagee or contract seller(numbs d street,city,state,and ZIP
Named assignee or otter owner or holder of mortgage
4 y) - 2 -.3 -/.0, / 25, 1 a
Address of assignee(number and street city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District-, I
Outer county nl/7"f
in Indiana? ❑Yes 0 N
A person is not entitled to this deduction unless the person has a balance on the .3 A Pie-
recorder's
office(including any home equity line of credit that is recorded in the c I-I U P P I O A
COUNTY, J
Deduction approved in the amount of
20 20 20 20
Signature of County Auditor u 3 I .
•
I/We certify under the penalty of perjury that the above and foregoing inform "' J 1
n ' •/J\
'owner!contract buyer of the aforementioned property on date application is I
Signature frill name
•Full •/ent address.. -• .•-• t(num.• • •street city,state,and ZIP code) W S u �R o • (L
(gap . I 06 (. 3(A UI.(le
Person authorized by duly executed Power of Attorney'or by IC 5-1.1-12-0.7
Address of authorized person (number and street city,state,and ZIP code) I ` 130 I oo o.
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The penalties for penury can include imprisonment up to two and a half years and a fine not ib exceed$10,000. . .