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HomeMy WebLinkAboutMortgage_Naas (3) assg. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year r--= .t FOR DEDUCTION FROM ASSESSED VALUATION �P State Form 43709(R13/10-15) Si.! Prescribed by Department of Local Government Finance I'-" Ti- r .n 'n. V's ,.j 1 i —lit S_ n e� k To be filed in person or by mail. Form Ned with: Filing Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought n('T 1 Must be filed or postmarked with the County Auditor or County Recorder of the county where the pro(le7ty isl 7 2 1 i© County Auditor boated on or before January 5 of the immediately succeeding calendar year 2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the ••unjy County Recorder where the property is located dining the twelve(12)months before March 31 of each year the dad=r. ; See reverse side for additional instructions and qualifications. GIBBON COIIN Applicant(owner o ct buyer-see on reverse LO- TY AUDITOR �_�l16►- �jS ► -, oga . th 11 cam Taxing District 1 � J� 400- ova - ga-Da y Record/umber� i 4m y Assessed value of real property as of IO Mortg age/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole assessment date,current year �a0 afrr t year J i to of application legal or equitable owner? Yes ❑ No If no,what is his I her exact share of interest? -_ — I If owned with someone other than spouse.indicate with whom If name on record is ddfererd than that of applicant,indicate below. I •in question:Annually Assessed • I I''-1 Mobile cent/ ❑ AnnualyAssessed Mobile Home(IC 6-11-7) Name of mortgagee or contract seller �' L Kai Ni A ,AS STEP 64)n el of mortgagee or contact surer(number and street,city,state /�Y//� Name of assignee or other owner or holder of mortgage h D I A y' ' Address of assignee(number and street,city,state and ZIP code) //' �i�L,/r)� other county own property in any If yes,what county? 1 I Tor G� 1 yes,state amount of deduction in Indiana? ❑Yes ❑No V y I ' I �) A person is not entiLed to this deduction unless the person has n ,OL prr °N^'"_ o that is recorded in the county recorder's office(including any home equity line of credit that is (�C.v he deduction. co Deduction approved in the amount of 0-.07/h/•l (Jhl\(J D , 20 20 20 20 Signature of County Auditor month,day,year) I/We ce ; under the penalty of perjury that the above and it is a resident of Indiana and - er I 7, tract buyer of the aforementioned property on de Sig r yJw . hill.am: moat,day,year) .1111 t 11 I l-;1 ull `::.•dress of t(n ber and street dry,state,and D. Person authorized by duly executed Power of Attorney or by IC 6-1.1-11 ninth,day,year) Address of authorized person (number and street x perso ( 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.