HomeMy WebLinkAboutMortgage_Whitehead (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
11'_-,4. FOR DEDUCTION FROM ASSESSED VALUATION
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State Fortn 43709(R73!10-15)
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Prescribed by Department of Local Government Finance
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-INSTRUCTIONS: j Fil
lb be filed in person or by mail. .1 0
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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 Auditor or County Recorder of the county where the propertvlsr 5 County Auditor
located on or before January 5 of the immediately succeeding calendar year. - O 11.,�l °County Recorder
Mobile/Manufactured Homes not assessed as Real Properly Must file with the County Auditor of the county .
where the property is located during the twelve(12 months before Mardi 31 of each year the deduction is/,.r ght
See reverse for additional instructions and qualifications. •!•1!r.3V!!91h•i
-• (• : wcwfradbvyer- a-. - GIBSON COUNTY AUDITOR
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- • - '_¢..) .4r ` Record number Page number
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Assessed value of real property as of . •age!Contract indebtedness unpaid as of Mortgage I Contract Indebtedness unpaid as of Is the applicant the sole
assessment date,anent year assessment date,current year date of application � odd legal or equitable owner?
/-10, odd ❑ Yes ❑ No
If no,what is his/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 belay. Is the property in question:Annually Assessed
VReal Property ❑ AnnualyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number an city,state,and ZIP ) ////�1//
Name of assignee or other owner or holder of mortgage r / /� 3.5 - - 9
Address of assignee(number and sbee4 Wy,state,and ZIP code) \T,(/ Qn
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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 property for
In Indiana? ❑ an ❑
Yes ❑No =rent year? Yes ❑No
A person is n.d 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 of..-__ •a+rline.of coedit that is recorded in the county recorder's office)that is the basis for the deduction.
9 l 5Q,COO co, JNTY AUDITOR
Deduction ar -
Drawer t\ro_&CIt )n
2o_ t0 20 20 20
Signature c Card No.NO. 305eo Date(month,day,year)
..................
r ll' I/We certify under the penny',r...,...:, rig information is true and correct and that the applicant is a resident of Indiana and
rowner/contract buyer of the aforementioned property on cram.,.,..:cation is filed.
- re(owrrers frA.name) Date(month,day,year)
L- fly -x-C rl—
,/ fF address of ap1p5c nt(number and sheet city,state,and ZIP code)
1(I, Person authoriz duty executed Power of Attorney or by IC 8-1.1-12-0.7 1 v 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. •