Mortgage_Lavanway (2) •^'nq STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
. FOR DEDUCTION FROM ASSESSED VALUATION
. r. State Form 43709(R12/6-14)
-r; Prescribed by Department of Local Government Finance � 1
INSTRUCTIONS: IL �F �• nrk
To be filed 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 smelt,/
Must be filed or postmarked with the County Auditor or County Recorder of the county where th 2 'p is neut. ounty 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< he cou
where the property is located during the twelve(12)months before March 31 of each year the d:f�.'1.l 4044
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Applicant(owner tract buyer-see resbictiO vecsaid
Taxi D tri n Key number/legal description 1:2) -a-�� Record 1ryn111ei( Page yetts
of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,arrpoty date of application legal or equitable owner?
[.i O O ❑ Yes ❑ No 17-0
If no,what is his/her exact share of interest? I 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 Assassed
❑ Real Property ❑ Annually Assessed .
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller . ' —�}'�/�C1. � `J`r`
Address of mortgagee or contract seller(number and street,city state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property it '' es,what county'? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county r - on property for
in Indiana? ID Yes `r1 V current year? ❑yes ID
A person is not entitled' ' 1 ,person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(inclu' :'di(that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR .
•
Deduction approved
1-)/ •�
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2f ' f1:O r- ) 20 20 20
en
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S'_• .. - County 1--1 o O •.O/� County
�jf 1�� Date(month,day,year)
• I�LJJ v/ U�
I/We certify under the penalty of pep- ••.• formation is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforemention< •.rr on is filed.
i• .lure(owner's full name) / Date(month,day,year)
ull resident a•dress 7of applicant(nu be.and street,city,sta'-"and ZIP a. )
4 7!/179�U r /c� •• D4./4/. /i /,��Pn ` 26 X40
Person authorized by duly executed Power of Attomey or by IC i1.1-12-0.7 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.