HomeMy WebLinkAboutMortgage_Doyle (2) x . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
'^ State Form 43709(R13110-15)
�-` Presorbed by Department of Local Government Finance IF JFI M8E
INSTRUCTIONS:
lb be filed in person or by mail Form filed with:
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought O C T � zui& Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder t,I
2) Mobile I 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 is so
See reverse side for additional instructions and qualifications. G I BSON COUNTY AUDITOR
Applicant t((owner�or�contract buyer- on rse side)
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Tape Key number/legal c peon Record number Page number
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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 assessment date,orient year date of application legal or equitable owner?
Ca,'''f) o c o ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
If nacre on record is different than that of applicant,indicate below. Is the property in question:Annually Assessed
0 Real Property ❑ Annually Assessed
' Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract sel _
Address of mortgagee or contras seller(number and street city,state,and L rC vh \ o Q C
Name of assignee or other owner or holder of mortgage ��
Address of assignee(number and t dry,state,and ZIP code)
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Does applicant own property in arty t yes, ;county? What Taxing District? Has this deduction peso._; Juction
otter on property for
in Indiana? Yes ❑No current year? Li Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contact indebtedness that is recorded hn the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount ot.
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.
k Signapr@(wfue3me) ,
if Date(month,daY.year)
.�Full resident address of applicant(�%ben and sheet thy,state,and ZIP code)
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Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 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 Iwo and a half years and a fine not to exceed$10,000.