HomeMy WebLinkAboutMortgage_Bartell STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
s '%' FOR DEDUCTION FROM ASSESSED VALUATION
0 State Form 43709(R13/10-15)
— Presrnbed by Department of Local Government Finance
•
INS eRUCTn person D
To be filed in person or by mail. 1 Fo
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought County be filed or postmarked with the County Auditor or County Recorder of the county where the property is ty Auditor
located on or before January 5 of the immediately succeeding calendar year. ��pp Ntnty Recorder
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 reverse side for�add�itional instructions and qualifications.
M
Applicant(owner or ' ! buyer-see resbi- - on reverse side) r1
GIBSON COUNTY AUDITOR
Taxing District " a Record number �a a�Z o )b -Col .2 &- ar
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,anent year assessment datecicuznt ye tki t owner?date of application legal or equitable ownerIhe ?
❑ Yes ❑ No
If no.what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of sppliant,indicate below: Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller O ^
Address of mortgagee or contract seller(number and abcet,city,sate,and ZIP code)
Name of assignee or other owner or holder of mortgage -
Address of assignee(number and street,city,state,and ZIP cc
.� / 11
Drawer NO �"\\\J ••
Does applicant own property in any If yes,what county? 6 T i W If yes,state amount of deduction
in Indiana?county ...0 o 6 1
in lndiana7 ❑Yes El No Card NO. . to
A person is not entitled to this deduction unless the perm rdness that is recorded in the county
recorder's office(including any home equity fine of credit is for the deduction.
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Auditor County - Date(month,day,year)
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 l contract buyer of the aforementioned property on date application is filed.
Sig re(owners MI te ^ Date(non'_day,year)
• address pphant(number street,(Al.slate,,and ccode) l
V ac,A Ptor►� y76 70
Person authorized by duewled Power of Attorney or by IC 8-1.1-12-0.7 Date(month,day,yea,)
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.