HomeMy WebLinkAboutMortgage_Greenwell (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS county Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R73/70.75)
Prescribed by Department of Local Government Finance
INSTRUCTIONS:inr I Fr To be h7ed incon or by mad Fifmg Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the CountyAudiitor or County Recorder of the county where the property is County Auditor .
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property.Must tile with the County Auditor of the county DE �Recorder
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and..-r. .-lions. ' • n ,
boyar .. cot 12 k �' O �T AI:
`/�),,�,/�_ 1�/\// GIBBON COUNTY AUDITOR
T= a:. /legal desaWtian Record e r
i� • ' . r f3 -/at- Q6-/ //- a 79: jai $
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of - Mortgage/Contact-i unpaid as of is the apparent the sole
assessment da_,arrant year .lead data,anent year date of appfaafion �r / legal or equitable owner?
('�J%/,(j/ ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than styli ca,- with whom
If name on record is different than that of applicant,indicate below lo property in question:Annuafy Assessed
¢g Real Property ❑ Toe 1.1-7)
a
Nen of mortgagee or contract seller f Mobile Horne
Address of mortgagee or cadrad see,( and sheet dty,state,cord ZIP
Name of assignee or other owner or holder of mortgage '
Address of assignee(number and street cdy,,stale,and ZIP code)
Y- t `/Lu 03 —/-/0 3. 3A .
Does applicant own property in any If yes,what county? . What Taxing District? Has this deduction been requested If yes,state amount of deduction
inbea ry ❑Y No current ?
es ❑ ❑
? Yes CI 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 '
recorders office(mduduw anvhome equity fine of 1aedl that is recorded nr the county recorder's office)that is the basis for the deduction.
approved $3 2 j\v J 0 tn.v.. Q NCCtI ac 1`AUDITOR "
Deduction n me It
20 id rQ) I4 Q I _ 20 20 20
eir Signature of County Audi (e t ' o 4 to Canty Date(monm,day.year)
/We certify under 1 4 lb-Alt-4c iiafon is true and coned and that the applicant is a resident of Indiana and
owner/contract bu . ...-.---_.--. _ :filed.
.., -„ (. �,.J.t�/) 1 - Date(norrtlr,day,year)
`/ F ���.t Less of appfipM(number and Meet, ate,and ZIP 4nde) .r-
1X` �( 3S h) C A-rr?-14v (CT f )`'c�,ii' Y Y.) /!'1600
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet 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 910,000.