HomeMy WebLinkAboutMortgage_Cross ---(.44: ., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
• FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13 1 10-15) _ .
Prescribed by Department of Local Government Finance F'I Ile E D
INSTRUCTIONS:
To be filed in person or by mad. - Form filed with:
Firing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. DEC 2 7 ,rfi�.g�
Must be filed or postmarked with the CourityAudifor or County Recorder of the county where the property is Ey��Tatnty Auddor
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 Cormty Auditor of the co, .
where the property is located during the twelve(12)months before Mardi 31 of each year the deduction is -
See reverse side for additional instructions and qualifications. G IBSON COUNTY AUDITOR'
Applicant(owner bulpr-see restirtiopyon re .
'faxing District �( Key n /Iegai Record r Page number
- D f-a5- 1100 ^ 900 .�'6a-000 1 L( A'I3
Assessed value of ram property as of Mortgage I Contract indebtedness unpaid as of . Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment dot°,current year dare,anent year date of application legal or equitable owner?
14 rit�t 0 Yes 0 No
if no,what is his I 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 , —n Is the property In question:Annually Assessed
.nmaaaty ❑ Annually Assessed
Mobile Nome QC 61.1-7)
Name of mortgagee or contract inter
R
Address of mortgagee or contact saes(number and street,shy,stale,and ZIP code) Di-,)
Wei. \'pa
Name of assignee ootaowner or holder of mortgage •.. 0/2p —
Cdr
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Address of assignee(number and sheet athy,sae,and ZIP code) • O 78
Does applicant own property in any If yes,what county? - What'faxing District? Has this deduction been requested If yes,state...••••,• m
other calmly on any'eIrdaha? ❑Yes iii No arrant year?for ❑yes ❑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 '
recorder's office(indudmg any home wally fine of dealt that is recorded in the county recorder's office)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 Aerator County Date(month,day,year)
I I 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 I contract buyer of the aforementioned property on date application is filed.
(own fry ) Date 1.---"t car)
'� I a unal I li
utl address of applicant(number and street city,state,and LP code)
(b)t S. aid &m A4 RD. Reaka Sy 4766&
authorized by duty executed Power of Atlomey or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet cif 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.