HomeMy WebLinkAboutMortgage_Faith (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
ttFF'11�° FOR DEDUCTION FROM ASSESSED VALUATION
'° State Form 43709(R13/10-15)
� - Prescnbed by Department of Local Government Finance i( at
INSTRUCTIONS: )e 'i "
To be filed in person or by mail. Form mad—, .•r
Filing 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 County Auditor or County Recorder of the county where the is �E Auditor
properly D C
located on or before January 5 of the immediately succeeding calendar year ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the county
where the properly is located during the twelve(12)months before March 31 of each year the deduction is so •'7 , gain
See reverse sde�additional instrruuto�ns/and quafi1e ��/gnss.� GiBSONCOUNTrAUDITOR
11, Key "mber/legal r"` n7 u r e d u �6ot7a-1 /—oc3- 972— oat i
Assessed value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage/Contract bid tedness unpaid as of Is the applicant the sole
assessment date,wrent year assessment date,parent year date nt ppiGation legal or equitable owner?
(lJ0/ l�� ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone Either than spouse,indicate with whom
If name on record is different than that of applicant,indicate below 'Is the property in question:Annually Assessed
'ed
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Name of mortgagee or contract seller sr
Address of mortgagee or contact se➢e vr. m.- and abeet chi t state,,-ri
F—�= ` ' ` \
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Name of assignee or other owner or holder of mortgage
Address of assignee(number it f std OP' LP aide) Lc o / _� / / C r
Does applicant own property in an f what county? What
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in Indiana? ❑Yes ❑No I A person is not enticed to Ws deduccon unless the person has a Q /')/r,
recorder's office(including any home equity line of credit that is I 1 vv
Deduction approved in the amount of.. //j//�� \—(/'�) /J
20 20 20 .7 V I — iE ) 1 V!
Signature of County Auditor �'—`� •
•
I I We certify under the penalty of perjury that the above and for f and
owner I contract buyer of the aforementioned property on date
ignatur (owner's full name)" Y1C� 1 — — C.>•* tr , — I
Full . eat address�epphcant(number and street, state. ZIP code
�`I{1,` A5c1 1- U;�lnO r« ; r,cc)Fr\ .701 ' \lUib
` 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 street city,state,and ZIP aide)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.