HomeMy WebLinkAboutMortgage_Sisk (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS riff- Tp � Year
FOR DEDUCTION FROM ASSESSED VALUATION
' State Fani 43709(R13!10-15) _ ""'�
Prescribed by Department of Local Government Finance
INSTRUCTIONS:
RI 7Fla c
To be fired in person or by mar. • Form fled with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be fled or postmarked with the County Auditor or County Recorder of the county where t�h/1eeympp Couhy Auditor
located on or before January 5 of the immediately succeeding calendar year. GIBSON COUNTY Olrpyt Recorder
2) Mobile/Manufactured Homes not assessed as Real Property.Must lee with the InnmtyAuditor of the county
where the property is boated during the twelve(12)months before Mantra 31 of each year the deduction is sought --- - -See reverse side for additional instructions and qualifications.
Applicant( see re57rains on reverse side)
Taxing Distri number/Iegal desa�tion Record number Page number
�� .t� a --/ 9-/8- 3oq- boO . 706 — 0 X 4 1(0 3954,
Assessed value atreal property as of Mortgage/Contract indebtedness unpaid as of - Mortgage f Contract indebtedness unpaid as of Is the applicant the sole
assessred dale,amen year asst date,amen year date of application legal or equitable owner?
2 4, o 0 6 ❑ yes ❑ No
•
If no,what is his!her exact share of interest? If awned with someone other than cpmwe,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property In question:Annually Assessed
-_____ ❑ Real Property ❑ Annually Assessed
Mobile Nome(IC 61.1-7)
Nano of mortgagee or contract seller Kn / n — .
Address of mortgagee or contract setter(manberand street,city,state,and ZIP Via) ��` -Jos?�
Name of assignee or other owner or holder of mortgage ' /C[J —j95/
Address of assignee(rttmmber and street c>7y,state,and ZIP code) • �O
Does applicant own property in any If yes,what county? What Taxing District? " Has this deduction been requested If yes,slate con.-_..
other
&ndar ? ❑Yes ❑No - amettprnt year? ❑Yes 0 N
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 may fine 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 CountyArrddtor County Date(month,day,year) •
I t 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 (owner's fu5//nllam�e�) A Date(month,day.year)
Full resident address of applicant(number and street,city,state,and ZIP code)
.2 e4 Al thill S+- F-06 g(;.,hrA 1k. 47Ctits
Person authorized by exerted Power ofAltomey or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street dry,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.