HomeMy WebLinkAboutMortgage_Barton (2) a. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
f';;11 FOR DEDUCTION FROM ASSESSED VALUATION —
�Y State Form 43709(R13/10-15)
Presalbed by Department of Local Government Finance
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INSTRUCTIONS: , -in1Ni
To be filed in person or by mail Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought t�
Must be filed or postmarked with the County Auditor or County Recorder of the county whem the property is D E C ) I MeV Auditor
located on or before January 5 of the immediately succeeding calendar year. LI 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county County Recorder
where the property is located during the twelve(12)months before March 31 of each year the deduction is so .!. sr. i
See reverse side for additional instructions and quail 1' ' W rl►9h
Appriyfivner orcon abuyer-seerestrictionson GIBSON COUNTY AUDITOR
Pia-) 9Z T= i strict Key nu / tl Record number Page nu r
�- 0' /g_56– ,3ao-oo/ 99s-- oa tz 01o76 01 4
value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
- t date,current year assessment date,aurent year date of api n legal or equitable owner?
/ ' J ❑ Yes ❑ No
If no,what is his/her exact share of interest? If vaned with someone other spouse,"i dirate with whom
If name on record is different than that of appraant,indicate below: Is property in question:Annually Assessed
Rea)Property ❑ Annually Assessed
' Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller / / 71
Address of mortgagee or contract seller(number and street,city,state,and ZIP..•e if
Name of assignee or other owner or holder of mortgage
Address of assignee(number... a.--,city,stal-. .'nd ZIP code) - ' - - - � ..
a
Does applicant own property in . /-,what county? What Taxing District? Has this deduction been re If yes,.te amount of deduction
in Indiana? ❑yes ❑No current ear?? ❑Yes
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract d tedness that is recorded in the county
recorder's office(including any home equity line of aedit that is recorded rded in the county recorders office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 —I 20 20
Signature of County Auditor County "----•—�
I/We certify under the penalty of perjury that the above and foregoing infomration is true and co D)-a Ivey 7. t ^(/�JO
owner ct buyer of the aforementioned prope on date application is filed. 1�O,,,,l 7�
S'.. re(own- bull name) / / `
/�11/� Card Nt O. r7 (1J,),.
Furl --sent address of applicant(number and street,city,Jr.and I ZIP code) "••••••..
/y) 3o a '5 pho tic 4n1 'Ran HAuhj-1408, 7" L/71n/l _
Person authorized by duly executed Power of Adomey or by IC 8-1.1-12-0.7 1 Ia . .
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 510,000.
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