HomeMy WebLinkAboutMortgage_May (8) s '. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
-,r:
itt,` FOR DEDUCTION FROM ASSESSED VALUATION
State Form
43709 p
� Prescribed b D epar m ent of Local Government Finance FILE
INSTRUCTIONS:
lb be filed in person or by mail. Form filed with:
Filing Dates 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 Audits or County Recorder of the county where the property is 4 Li bounty Auditor
boated on or before January 5 of the immediately succeeding calendar year. C un ecorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must We with the County Auditor of the courj/
where the properly is located during the twelve(12)months before March 31 of each year the deduction is
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
',nt(own r orcontract buyer-see -- • on • )•
T District Key number f legal description Record number Page number
N a „ z- A4. /8-36 _ go 3 - o o . a- 96-00 9 0/ 8ic,a a.
Assessed vabe of real property as of Mortgage I Contract indebtedness unpaid as of I Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment data,current year assessment date,current year date of application legal or equitable owner?
Sf_B_.._.._A. _ _ - ❑ Yes ❑ No
If no,what is his/her exact share of interest? '/ /�
If name on record is ddferent than that of applicant,indicate below: cM l`I t / et e_ES A ually Assessed
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?lly s
• __ / Al N e Home(IC 6-1.1-7)
Name of mortgagee or contract seller L
Address of mortgagee or contract seller(number and street city,state,and ZIP code) vvv^^^
Name of assignee or other owner or holder of mortgage Ivt. P!h-/ -174-De-0 IZ l�-!) V_
Address of assignee(number and street city,state,and ZIP code) r y r ' ` f- t..P r r_
Cu, 4t /J a0. O,.t.a- /la 6
Does applicant own propgrty in any If yes,what county? What Taxing Di: t ht&g v acv (� tint of deduction
other county FFF f
in Indiana? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance or ded in the county
recorder's office(including any home equity line of aedit that is recorded in
COUP
Of - 8?..0aa
Deduction approved in the amount of
20 20 20 20. 20
Signature of County Auditor aar)
I/We certify under the penalty of perjury that the above and foregoing it int of Indiana and
owner I contract buyer of the aforementioned property on date applicatic
Signs urre(owner's full name0 //�/�/1/'{/1 ear) --
,X\
knoll address of/arrant(} (number and � ,state,and ilf code)
/ 5 . tC.v11.o-osi it . .eN ----
Person authorized by duly executed Power of Attorney or by IC e-1.1-12-0.7 1 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.
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