HomeMy WebLinkAboutMortgage_Hedges (3) #c. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
y FOR DEDUCTION FROM ASSESSED VALUATION
vo - State Form 43709 par/10.15) zr� �r
Prescribed by Department of Local Government Finance Ilg1j-'I,, ipN�
INSTRUCTIONS:
to be filed in person or by mail. filed ;
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. OCT 31'2 1 6
Must be filed or postmarked with the CounlyAuditor or County Recorder of the county where the property is cagey Auditor ,
located on or before January 5 of the immediately succeeding calendar year.
2
III) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Comfy Auditor of the •• g a� '°' •err
where the property A. t�•--"::.
P Pero'is located during the twelve(12)months before March 31 of each year the deduction is-••�-�
See reverse side for additional instructions and qualifications. GIBSO COUNTY AUDITOR
r. )
��d _see „reverse side
Q4Record number Page number
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of • Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment data,assent year assessment date,anent year date of appfrafion yn /- O legal a equdablo owner?
/9Uri ❑ Yes ❑ No
If no,what is his/her exact sham of interest? If owned with someone other than 9w'n,indicate with whom
If name on record is different than that of appfrem,indicate be Is the ropeny in question:AnnualyAssessed
• aal Property ❑ Amway Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller 2
Offein Address of mortgagee or contract seller(number and street city,stake, P code) I'}6It _ Li VA
Name of assignee or other owner or holder of mortgage ' I Q( P-( € , 1t� 8 �o
•
Address of assignee(number and street,day,state,and ZIP code) ('A.B C_,Il & J7
V� 1/7 t)ci
Does applicant own property in any If yes,what county What Taxing District? Has this deduce
other on property
. Indiana? ❑Yes ❑No en yea U Ye u nu u
A person is not 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 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 at
•
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/co ,•:. buyer of the aforementi property on date application is filed.
Signature(• is 0 ��� // Date(momA,day, i l
Fug / at re;c Qf street, .state,arudjlP e) �� / �d
•>-.. authorized q•duly e:endetl of or by IC 6-1.1-72 . Date(month,day,year)
Address of authorized person (number and street dty,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 510,000. • - -