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HomeMy WebLinkAboutMortgage_Nussmeier �, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year 't'f FOR DEDUCTION FROM ASSESSED VALUATION �f° State Fonn 43709(R13/10-15) "-- - Presathed by Department of Local Government Finance INSTRUCTIONS: FII To be filed in pe or by mail. Ring Dates Real Properly:Must be completed and dated in the calendar year for which the deduction is sought I fi Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly is County Auditor located on or before January 5 of the immediately succeeding calendar year. n gounty Recorder 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the co r&P 2 9 10 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 Con -see on erse side) 7��19 + 1` GIBSON COUNTY AUDITOR ' Taring District a Key number a- 3 00 -0©3 7�9-N9 Record n�W r �CV.0 Assessed yam of mat p as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole assessment date,curtail year assessment current year date of application legal or equitable owner? I S 61)0 ❑ Yes ID 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 appricanl,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 ?r f � , ?7 6 Address of mortgagee or contract seller(number and q \saeeLl state,and ZIP IIP code))J„�(,/d,' - Name of assignee or other earner or holder of mortgage ^_�I J�Si— __ __ Address of mW l {JC.51 53 J - -- _- - assignee(number and street dry,state,and ZIF IIU . `iiy"NNrrss 1/\� Does applicant awn property in any If yes,what county? Drawer �t Q... ...M. .. ,uesfed If yes,state amount of deduction other county in Indiana? ❑Yes ❑No r_ ❑No A person is not entitled to this deduction unless the F Ca 1• 1r p. 9 debtedness that is recorded in the county recorder's office(including any home equity line of c e basis for the deduction. I:VUN I I"Ran I ton 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!contract buyer of the aforementioned property on date application is filed. tCe(owner's--t s m 0`2q 6 • Aresident address of applicant(number and steel city,state,and ZIP code) 3 3 b by datySexew executed U a t �y'2-0.7 �-b n 4 24 70 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.