HomeMy WebLinkAboutMortgage_Morrison (16) at STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
6 FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15)
Presorted by Department of Local Government Finance
INSTRUCTIONS: File ��M�tttt••a•••••A----c
lb be filed in person or by mail. r (,I�v�d�1
Filing Dates 1) Real Properly 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 courtly where the property is -et,' 19Auditor
located on or before January 5 of the immediately succeeding calendar year. I�--,-r�I County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the cor�i}yP 2 1 L IJ Is
where the property is located during the twelve(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 onreverse side) ���L .
n� e , /�•/l GIBSON�Ot1NT�t1-r�p
T " District KB r/legal description Record number YFag�Mhhber
?& - /a -o 7 - — o / — o o ?, O ' /- o )-8 2-0/ Co 1 37 9 8
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,anent year assessment date,anent year date of application legal or equitable owner?
-
3 5" 000 ❑ Yes ❑ No
If no,what is his/her exact share of Merest? If owned with someone other that(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 ❑ AnnuallyAssessed
' _Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller _
Address of mortgagee or contract seller(number and sheet city,state,and ZIP code)
.Drawer NO a2
Name of assignee or other owner or holder of mortgage ,
Card NO, 5 �-�fY
Address of assignee(number and sheet oily.state,and ZIP code) •••••••......
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on for
in Indiana? ❑Yes ❑No arrest yrt f ❑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 fine 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 oft
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.
Sig re(omen's full name) Date(month,day,year)
L!7�' (/� .-.- 4- 2 /- 2a/G
Altdrresident address applicant(number and sheet state,and ZIP code)
6-0 mss- Ail- S,-6 PA,,.:. / -- 4/76 zu
Person authorized by duly executed Power of Attorney or by IC 6-1"1-12-0.7 Data(month,day,year)
Address of authorized person (number and street oily,state,and ZIP code)
The penafies for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. •