HomeMy WebLinkAboutMortgage_Gress (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
,y `1 FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15) ITT g �{'
%, ' Prescribed by Department of Local Government Finance 4 .(F li C
INSTRUCTIONS: llRC mRanv.
To be filed in person or by mail. Form filed with:
Filing Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought I OotliViluditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is
located on or before January 5 of the immediately succeeding calendar year ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly: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 ,,r?+, q,nlji,
See reverse side forr additional instructions and qualifications. GIBSON COUNTY Al InhTOR
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Assessed value of real property as of I Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of appfiptbn "�/ legal or equitable owner?
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/// an ❑ Yes ❑ No
If no.what is his I her exact share of interest? If owned with someone other than spiouve.indicate with whom
If name on record is different than that of applicant,indicate below. Is property in question:Annually Assessed
Real Property ❑ Annually Assessed
' Mobile Home(IC 6-11-7)
Name of mortgagee or contract seller
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Address of mortgagee or contract seller(number and /Nstaate, ZIP'I
Name of assignee or other owner or holder of mortgage /�
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Address of assignee(number and street,city,state,and ZIP code)
Does applicant awn property in any I If yes.what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other cow n"---- on property for
in Indiana - — _ cement year? ❑Yes ❑No
A person S131 cL e Q r`�S y '-'--m on the person's mortgage or contract indebtedness that is recorded in the county
recorder JJ 1 O din the county recorder's office)that is the basis for the deduction.
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Deduct* �/ Jerry l Ce
2( �1 i� �� I ao (c - -t aL s 20 20 20 20
Sign- l (-flinty - Date(month,day,year)
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I/We certify under the penamy ur„c..w—., __ ping information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of/he aforementioned property on dale application is fled.
Signature(owner's fuM naye)7�j/{�J, /, f,/i� Date(month,day,year)
Full resident address of apppficann (mum and street%ty,state,and ifcode)
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Person authorized by duly executed Pa&of Attorney or by IC 6-1.1-12-0.7 Date(month,day.year)
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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. - . •_ - •
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