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Home My WebLink AboutMortgage_Williamson €�,. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year M FOR DEDUCTION FROM ASSESSED VALUATION State Form 43709(R13 I 10.15) — Prescribed by Department of Local Government Finance i i ce• INSTRUCTIONS: i i Ile ?© To be filed in person or by mail. Form filed with: Filing Dates 1) Real Properly Must be completed and dated in the calendar year for which the deduction is sought p E 2 B 2(I per, County Auditor Must be filed or postmarked with the County Auditor or County Recorder of the county where the property r qJ located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder 2) Mobile/Manufactured Homes not assessed as Real Prope :Must file with the County Auditor of t uno where the property is located during the twelve(12)months March 31 of each year the tied See mverse side for additional instructions and quaff •-.. GIBBON COUNTY A n 99'�ac--onv--aabuyer-see on - - _ �• w U ITOR T Key !legal•- number Page m 3/( /ev oaa�� oaf 0/6 � d watts of real property as of Mortgage I Contact indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the applicant the sole date,current year assessmem date.parent Year data of apprxxiion Jz legal or equitable owner? Cj r U ❑ Yes ❑ No If in what is his/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 Istbe property in question:Annually Assessed Real Property ❑ Mobile Home Mobile Home(IC 61.1-7) Name of mortgagee or contract seller �� /� ' 4 /,1 ` n Address of mortgagee or contract seller(number and street,city,state,and ZIP !cod'.e)) Name of assignee or other owner or holder of mortgage //////��!!! Address of assignee(number and street,city,state,and ZIP code) / / /1J-t�/) � � / Does applicant own property in any If yes.what county? What Taxing Disticf? aas this f Uion been regquuesstted- If yes,state amount N`/detluuction other in Indiana? ❑Yes ❑No curmront -r? ❑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(including any home equity line of credit that is recorded 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 20 20 Signature of County Auditor 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. Signature(owners full name) - Date(month,day,yea') W sue—,-- Full resident address of applicant(number and street city,state,and ZIP code) «an I 3• a 0 E, \Aa tis hs 4-4 CIA- , IN '47b3? Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,yew) 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$10,000. .