HomeMy WebLinkAboutMortgage_Rausch a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
t- FOR DEDUCTION FROM ASSESSED VALUATION
r%- �(- State Form 43709(R13/10-15)
Presaibed by Department of Local Government Finance t� li it
INSTRUCTIONS:
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lb be filed in person or by mail. Farm filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought SS
Must be filed or postmarked with the County Auditor or County Recorder of the county where the propel is 2 6 `9
1 J6County Auditor
boated on or before January 5 of the knmediately succeeding calendar year. • Co •• Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the •• 'ty • 4 _t•
where the property is located during the twelve(12)months before March 31 of each year the deduction cL ;:.., *J 1 V:r
See reverse side for additional instruction andquafifcato GIBSON COUNTY AUDITOR
Ap• c _i era contract buyer-sees / ^,•a o.n rave '$ . I
/ 27 RemN number Page number
�a/- oa/. /7oz-aG7 1 (D LIH1 ti
Assessed value of real p••- . of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,• . r- assessment date,current year date of application legal or equitable owner?
io ❑ Yes ❑ No
If no,what is his/her a=ct share of interest? 'If owned with someone other than s(LXpouse,indicate with whom
H name on record is different than that of applicant,indicate belay. s property in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage ]
Address of assignee(number and street dry,state,and LP code) /)/P /
Does applicant own properly in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
in�iMiana? ❑Yes ❑No current fir?r ❑Yes ❑No
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 of:
20 20 / 20 20 `�6-vs \Ci.,Lrw\V\4N..SG1'\.�J —
Signature of %Or r/ County J r . Q o--NA
�!i„ :� aSo ooe. oa
�h I/We certify under the penalty of perjury that the a•'ire and foregoing information is tr t ma and
120 owner!contract buyer of the aforementioned property on date application is filed.
/ Signature(owner's fulnem�eje I r ��
(X- .fit PI P&L-ft I
resident address of applicant(number and street city,state,and ZIP
code)
-41ols1 S c nk he 5-/- erertanae4
', .iii• '/760
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7f 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 two and a hat years and a fine not to exceed$10,000.