HomeMy WebLinkAboutMortgage_Freeman STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
4ti Stath Form 43709(Rl3I 10.15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS:
To be filed in person or by mad. vttt,;
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is so t. r�
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 J a n u a r y 5 of t h e i m m e d i a t e l y s u c c e e d i n g c a l e n d a r y e a r. MALI?
r-(` q 7 2 O
2) Mobile/Manufactured Homes not assessed as Real Properly.Must file win the Courtly Auditor of elAbthli�+ minty 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 qualifications. •,91 applicant(owner or -see restrictions P reverse side) -
GIBSON COUNTY AUDITOR
Disbict Key numb /lead desaiption
/7-0 -10 01 0• aq--oaa Record(0 5389
Assessed value of real property as of Mortgage t Contract indebtedness unpaid as of • Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,=rent year o ca�a,mvd d�,putpptO� date of application legal ❑�able ❑ N
If no,what is his I her exact share of interest? (��(`t F`JL7) If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant indicate below: Is the property in question:Annually Assessed
• ❑ Real Property ID a y 6-1.1-7)
Nate of mortgagee or contract seller E 1 6/-1}/'C •
Address of mortgagee or mrdract seller(number and street aly.state,and ZIP code)
Name of assignee or other owner or holder of nr-_—--
-0 1 x--Se3%5
•
Address of assignee(number and sheet,thy,sta 1 �v\ VC°,�'MCYw
Al SSc
Does appitant own property in any If yes,who Y G gD15' dYian been requested if yes,state amount of deduction
in
other county Indiana? ❑Yes ID No �`� Z' ❑Yes El No
A person is not entilied to this deduction mete recorder's office(including any home eqully I 1'-- ate— `CO v)that is indebtedness bads the that is cio. in the county
e)that is the basis for the deduction.
wun TY AUDITOR "
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature `/:.c... I / County ) Date(moNh,
�� _ I 1" !/tom.% a ti i4 /o�, 7-1 -
I e certify under the penalty of perjury that the above an regoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
( lA/nmmmee))) Data(month,day,year)
( end of applicant(number and street city,state,and ZIP code)
r 203 n1 Ma,pl S+. OfrdeAlsvtil.e1In/ 47665
Person authorized by duly executed Power of Attorney or by IC 61.1-12-0.7 Date(month,day.year)
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 S10,000.