HomeMy WebLinkAboutMortgage_Jarboe (2) h�az . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(pa /10-15)
�- Prescribed by Department of Local Government Finance
ELL Fs lip
INSTRUCTIONS: ^(�' fed
To be Oat in person Real l ro mail. F,L ie n 21116
Filing Dates 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought l J Co
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly is unty Au i or
located on or before January 5 of the immediately succeeding calendar year. County ec rife -
2) Mobile/Manufactured Homes not assessed as Real 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 sought
See reve ' for additionalinstrucfmns and qualifications. GIBSON COUNTY AUDITOR
Appacan er contract buyehsee - on re -rse side)
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Assessed vakhe of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole •
assessment data,aurent year assessment date,current year date of application „/ „ legal or equitable owner?
��i(//G'71//CfeP ❑ Yes ❑ No
If in what is his/her exact share of interest? If owned with someone other than spoust,indicate with whom
H name on record is different than that of applicant indicate below. ` Is the property in question:Annually Assessed
XReal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller j/%31 71,2(..e—s
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,sta code
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Does applicant own property in any If yes, t O. What Taxing District? Has Has deduction been requested If yes,state amount of deduction
other ❑Yes ❑No • arnennt yeaR for ❑Yes 0 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(mending any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
peat !\ e /(�' ` , .�7sv (9 u L - Jr . COUNTY AUDITOR
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20 20 20 20
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Sign / - County • •Dam(month,clay,year) •
1 nd foregoing information is true and correct and that the applicant is a resident of Indiana and
c....... date application is filed.
Signature°`v 7 ..e) Data(o.wnfh,day.year)
Full resident address of-..., t number and street,ay,state,and ZlPrcode)
/ 539',. S. / 2 7,5 c C24fi4-4-,r/) Cy -r/ y 7460
Person authorized by duly executed Power of Attorney or by IC 6-7.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street oily,slate,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.