HomeMy WebLinkAboutMortgage_Hardin STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13110-15)
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Presorted by Department of Local Government Finance gq
INSTRUCTIONS: gg� p 1 l Form
To be filed in person or by mail. A
Filing Dates' 1) Real Properly.Must be completed and dated in the calendar year for which the deduction is sought ,,,lli���AAA
Must be filed or postmarked with the County Auditor or County Recorder of the county where the prop iy 5 / County 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 of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction' ught
See reverse skis for additional• sbuctions and qualifications.
Appliant(owner or contraa�restrictions?ever,te GIBBON COU` 1Y AUDITOR
Taxing District Key number/ll egal description Record number Pa9 u r
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Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessrigate,t d current year date of application legal or equitable owner?
C��% ( 66D El Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse.indicate with whom
It nacre on record is different than that of applicant,indicate below-. Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
0 it A. Ligevl
Address of mortgagee or contract seller(number and sheet city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage .__
Sao A.��V'�\\�
Address of assignee(number and street city,state,and ZIP a
Lc, 'pS t- t .
Does applicant own property in any If yes,what county? :fed If yes,state amount of deduction
other county � — Jc6 C
in Indiana? ❑Yes 0 No INo
A person is not entitled to This deduction unless the per: & c D otedness that is recorded in the county
recorder's office(including any home equity line of aed, ■ S"U 3sis for the deduction.
Deduction approved in the amount of.
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
/contract buyer of the a fforrementioned property on date application is filed.
rer Vl . CA/Cad yDate(month,day,year)
Full address of apprcant(number and city,state,and ZIP code)
1144E boo S }t f. •.9vt. 476V ,
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet dy,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.
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