HomeMy WebLinkAboutMortgage_Griffin STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS aulnty Township Year
FOR DEDUCTION FROM ASSESSED VALUATION .
: State Form 43709(R13/10-t5) -. •
-.. Prescn-bed by Depattrnent of Local Government Finance I, I L! G ,. j File Mark
INSTRUCTIONS: J �J AA��
To be filed in person or by mall ff'' nn ri� nqn�11C Form with
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for whidrktpe&udfioh4Ssought.
Must be filed or postmarked with the County Auditor 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 Read Property-.Must Re wills 7 - • of the county ❑ county Recorder
when the property is located during the twelve(12)months before March 31 .-.11_*"7 � .:-
S"reverseside • additional , n., s and qualifications.) GIBSON COUN "•� � � -
get 1 et cri Ms a / Key �d , Record number
(P-17— /7—a IA 01. 511_ o d/ 5 3 c�
Assessed vatue assessment da prmoperiy of ASodgage! indebtedness unpaid as of • data of a indebtedness repaid as of a the solar?
ben
, • ❑ Yes ❑ No
if ro,what is his I her exact share of interest? / If owned with someone other than gxnicn,indicate with whom •
If name on rend is different than that of applicant,indicate below. Is t e property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
�-1
/� Mobile Horne QC 6-1.1-7)
Herne contr
Nae of mortgagee or act seller ej ' I /ti
Address of mortgagee or contract seller(number street city,/V/
ru r
state,and d ALP code)
1 Name of assignee or other owner or bottler ofnugage
Address of assignee(number and street thy,state,a•'- ; - - - • - - - -
Does applicant own property In w—" Q V�� `J� Taxing District? Has this deduction been requested If yes,state amount of deduction
other inlMana? ❑ it ') V1(�-,.,( anent? ❑Yes 1-1
in on
A person is <23 pr'1" nce on the person's mortgage or contract indebtedness that is recorded in the county '
recant- (...)p..-- l 1-1 „ ''td in the county recorder's office)that is the basis for the deduction.
1U lL, COUNTY AUDITOR "
Deduct \
•
20_ 20 20 20 20 20_
Signature of h - -Canty Date(n oath,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.
nahpr;(gwncls name)_ ,1 • Date(month,day.year)
ill resident address of applicant(n and street city,stall and ZIP code)
lo4a I vi faJ— r:?&, hits Clieac ;iip I'rl) '/7%;
authorized by duty executed Power of Attorney or by IC 6-1.1-120.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP coda)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10000.