HomeMy WebLinkAboutMortgage_Market a, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION•
State Poon 43709(R13/10.15) .
Prescribed by Department of Local Government Finance
INSTRUCTIONS: rFI t rk ,
To be filed inperson or by mad. , f' ,_i--
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. ' I 1�)
Must be filed or postmarked with the CountyAuddor or County Recorder of the county where the property is ■ .i•• a
located on or before January 5 of the immediately succeeding calendar year. '
2) Mobile/Manufactured Homes not assessed as Real Property-.Must file with the County Auditor of the county D:
ply,l2emrder
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought 11�U
See reverse side claims)instructions and qualifications.
Applicant(armor or A buyer.see m alai
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' 0l�� GIBBON COUNTY ALIT�R
Taxing Distdct , number/ Reaord Page number
I 6- ia -i on-ocn-r07- bag � r Livia
Assessed value of mal property as of Mortgage/Contract indebtedness unpaid as of - Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,amen year assessrnmd amen[ypar data of application legal or equable owner?
(�(�l(C/i\ ❑ Yes ❑ No
If no,what is his l her exact share of interest? ( If owned with someone other than spouse,indicate with whom •
If name on record is different than that of applicant,indicate below:/ die e property In question:Annually Assessed
2 t(O i Co ❑ Real Property ❑ /vmuatlyA55assed
Mobie Home(tC 61.1-7)
Marne of mortgagee or=tract seller
Address of mortgagee or contract seller(number and . . . ._.___ —
A.(y ply y
Name of assignee or other owner or holder of mortga J k�Q-`S \ 1yy '�C \ \ 6
Address of assignee(number and streetd state,e t.7 tr C0- ' 3S t 60 .00
Does t own property in any ayes,what cc a0 lL– U Ls '- in been requited If yes,state amount of deduction
in Indiana? ❑Yes El No ❑yes 0 N
A person is not entitled to this deduction unless 1– "L'–'`° xlntrad indebtedness that is recorded in the county
recorder's office(mdudng any home equity fine or treat mar rs resolves n me county rewroer s aunxf 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 I We certify under the penalty of perjtiy that the above and foregoing information is this and coned and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is fled.
Sign ( i fu➢r a / n /L Date(month,day,year)
emaddress of- %,( .- wd atY state, PP�code) n II
Person audor¢ed by duly executed Power of Attorney or by IC 61.142-07 Date(month,day,year)
Address of authorized person (number and street,ray,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.