HomeMy WebLinkAboutMortgage_Loveless (8) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township rlty p Year
FOR DEDUCTION FROM ASSESSED VALUATION
°, '.: State Fonn 43709(R13/10-15)
Presaibed by Department of Local Government Finance
INSTRUCTIONS: F I L , , .ii)
To be filed in person or by mail. g :
Filing Dates 1) Real Property Must be completed and dated in the calendar year for whidn the deduction is sought Jnnn�
Must be bled orposbnarIcad with the County Auditor or County Recorder of the county where the prcrrty is, 7 2 0 L County Auditor
located on or before January 5 of the immediately succeeding calendar year. 1
2) Mobile/Manufactured Homes not assessed as Rea/Property:Must file with the County Auditor of the county County Recorder
where the properly is located during the twelve(12)months before March 31 of each year the del .1*u" sough
See reverse side for additional instructions and qualifications. 1 4-;y!/in
AppiMer orcontraci see caonsonre GIBSON COUNTY AUDITOR R
Taxing District Key number/legal description Record n r Page number
.l a-E�.'I- I D - O00. 863 Da AT) 36111
Assessed value of real property as of Mortgage f Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,ainent year date of application legal or equitable owner?
S-
(0 Onr,(v� ❑ 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 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
Si3
Address of mortgagee or contract seder(number and street ay,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
1465; coo. f— a-o /e — 30 VS
Address of assignee(number and street city,state,and ZIP code r O y
I r 1 e e - /r /of-'a,f/
Does applicant own property in any If yes,what county? Drawer N O eta If yes,state amount of deduction
other county
in Indiana? ❑Yes ❑No No
A person is not entitled to this deduction unless the person - 'edness that is recorded in the county
recorders office(including any home equity line of credit t Card NO. sis 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
owner/contract buyer of the aforementioned property on date application is filed.
S (ads name) Date(month,day,yam)
F r em /address of applicant(number and aTy,state,and ZIP e)
e3-Zzj,_- G� f • fe7o 7o
P authorized by duly executed Power of or by IC e-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street ay,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.