HomeMy WebLinkAboutMortgage_Prater } STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County , Township Year
(9; FOR DEDUCTION FROM ASSESSED VALUATION
�')-'( State Form 43709(R13/10.15)
Presented by Department of Local Government Finance
INSTRUCTIONS: , ;, Tel?",
7b be filed in person or by mail 1 � I
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 Audios or County Recorder of the county where the property il.,E P 2 ff �Cto��unty Auditor
located on or before January 5 of the immediately succeeding calendar year. rjetrnty Recorder
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 twelve(12)months before March 31 of each year the deduction is sou et t
See reverse side for additional instructions and qualifications. , ��iinywdi
Appl• ntwn6act blryert r versg�ide) ' _ .....
7L1/ V- ez GIBSON COUNTY AUDITOR
Taxing District Key number I legal description • Record number Page number /
o't& - / 7 -/oZ - o2OY - ooO .5 .t/-0A )_ I & 35x•5
Assessed value of real property as of Mortgage I Contact indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of aplicition legal or equitable owner?
eI000 ❑ Yes El 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 different than that of applicant,indicate below- Is the openy Pro perty in question:❑ Annually Annuaw Assessed
• �
- , Assessed
_-- Mobile Horne(IC 6-11-7)
Name of mortgagee or contract seller i r f RA �.
7�17C
Address of mortgagee or contact sever(number and steel.ally,state,and ZIP code) •
L 65 A-n Q
Name of assignee or other owner or holder of mortgage
gRASU K
Address of assignee(number and steet dry,state,and ZIP code)
P r NE - /01 - 3 -m i'l A c ) (0 35o5
Does applicant own properly in any If yes,what county? What Taxing District? Has this deduction been requester, 1,,r _-,
wana?? ❑Yes ❑No on year? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's moilyage 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!contract buyer of the aforementioned pro erty on date application is filed.
Sig s name) Date(month,day,year)
no _at-
k ` 't `. ` `9L°11 ee/`/o/!/lrN��an J✓/�' /4 2/1(.er
Person authorized by duty executed Power ofA.wrnLg or by IC 6-1.1-1241.7 / Da(month,day,
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 S10,000.
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