HomeMy WebLinkAboutMortgage_Powers (8) tea, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
tFOR DEDUCTION FROM ASSESSED VALUATION —State Forrn 43709(R13110-15)
Presalbed by Department of Local Government Finance
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INSTRUCTIONS: F,j- , t,-
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.•To be filed in person or by mail. - orm6fe3 ; .
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 property is DEC 2M anbitty Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile I Manufactured Homes not assessed as Real Pro County Recorder
Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sou. • i—•�
See reverse side for add' al instructions and qualifications. ( 4WM11.
Applicant(owner or contract seem. " . on refs? GIBBON LOU 1 Y AUDIFOR
Taring District number/lega description Record number Page n mbar
61(0 - e4-os - 1400 - 00(Q. 313- 0�,� 10 X311
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year d'3-t�@J'of applxation legal or equitable owner?
l I 6 DO ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with somJone 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 ❑ AnnualyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(ru -
Name of assignee or other owner or holder 1 OLG vu (/v a
Address of assignee(number and street c /10- 5311
Does applicant awn property in any If yr is deduction been requested If yes,state amount of deduction
ti�Indiaannan? ❑Yes ❑No t year? ❑Yes ❑No ,
A person is not entitled to this deducb_._.____ gage or contract indebtedness that is recorded in the county
recorders office(including any home equity line of Credit that is recorded in the county rewrucrs 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,yea,
I/1Ne 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/contract buyer of the aforementioned property on date application is filed.
re er nt i fir 4-wy5 Date(month,day,year)
/�Xr&o I CppM1Can (Doan 3lmet ill p qe.and ZIP Code)/� (la 7C. ?o
Person authorized by duly executed Power of_Attorney or bbyyIIIC`6-17.1--1121-0.7��(L"•l 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$10,000.