HomeMy WebLinkAboutMortgage_Gamblin r ?. STATEMENT
EDUC IO OF MORTGAGE S ED ALUAT INDEBTEDNESS Cou Township Year
;!�'°>�- S FOR DEDUCTION FROM ASSESSED VALUATION �1
State Form 43709(R13/10-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mat NOV ¢,
Filing Oaten 1) Real Properly Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property ❑ 'linty Auditor
located on or before January 5 of the immediately succeeding calendar year. •• :i h j; •unty Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor(if Imsv►Ntu
where the property is located during the twelve(12)months before March 31 ofeah year the deduction is sought - -
See reverse side for additional instructions and qualifications.
Applicant restrictions Law
Taxing District Key number/legal description Record number
nce_a_re4en &L- K- IQ.-`(DI 'CO (• g � /fn Y
Assessed wake of real property as Mortgage/Contract indebtedness unpaid as of Mortgage/Co tract indebtedness unpaid as of Is the applicant the sole
assessment date,amend year assessment dot= n,nant//year --1 date of application legal or eq ble owner?_ ,OTC r es ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,intricate with whom
If name on record is different than that of applicant indicate below. Is the property in question:Annually Assessed
iceReal Property ❑ AnnuallyAssessed
• Mobile Home(IC 6-11-7)
of mortgagee or contract seller
�1t ,� fII� A//I"
Address of mortgagee or canlr eOer(numbs and street city,state,and ZIP code) — �v M L yr✓ i /J-/"y"
(~ 7r
Name of assignee or other owner or holder of mortgage v
Address of assignee(number and street oily,state,and ZIP code) i 6_ 14(1 13 county own property in any If yes,what county? What Taxing District? fb 50/Q Q 'eduction
Does other
in Indiana? ❑Yes No T"
A person is not entitled to is deduction unless the person has a balance on the person, m.:indebtedness that is recorded in the county
recorders office(including any home equity line of credit that is recorded in the county r.....,,uers office)that is the basis for the deduction.
COUNTY AUDITOR
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 tiled.
Signature y1 - -cull ) Date(month,day,Yea')
•
F _ resid C -f/6cant number and sheA _oty state and,ZlP� y+'✓ e 7140
0-
Person authorized by d 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 two and a half years and a fine not to exceed$10,000.