HomeMy WebLinkAboutMortgage_Michels STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
a : FOR DEDUCTION FROM ASSESSED VALUATION
S• a State Form 43709(R13/10-15) Tgggg' y-�
r Prescribed by Department of Local Government Finance A g ® 11
INSTRUCTIONS:
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. JAN 3.0 201±
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is County Auditor
located on or before January 5 of the immediately succeeding calendar year. C• my Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of th 4r.unty ��
where the property is located during the twelve(12)months before March 31 of each year the deduct'.• t;:•,_rr•71m't1it
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
"ant(o er or comma bu er-segre Lions n verse side)
D. YI ch&c Dove w . mi C eI5
i rig ¢ a Key number legal de puon R d u_ P number
n6� . 2&-iP)- Qatri .w . Li IC — ; flbq tint
Assessed value of !pro rty as of ortgage I Contract de_.-..........,.,-...-_ Mortgage 1-Conti-ad indebtedness unpaid as of Is the appli nt the sole
assessment date,anent year assessment date,current year aa1 7pplicatbn i' 0/� legal or eq table owner?
I �, V Yes ❑ No
If no,what is his/her exact share of interest? If owned wi someone cIther than spouse,indicate with whom
If name on record is different than that of applicant indicate below: Is a property in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7) -
Na p f mortgagee r contract seller
�0,�( e um� ik GA �Y1(}Pco0C1 G P C��.
Ad of m gee or contrseller(numpe n�strecpy,s' te,andalP ) I I\ v to `Itls0 V GY,•',YIISV I I f �1
Name of ssignee or :her owner or holder o mortgage
Address of assignee(number and street,city,sate,and ZIP code)
Does applicant own property in y If yes,what county? Wnat Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? III yes No current year? ❑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 recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 ( 20 20 I 20 20 I 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/contract buyer of the aforementioned property on date application is filed.
ig at r (owners full name m / Date(month,day,year)
I sidert dress of appli nl(number an street,city,state,and ZIP Tops.
U by my toG ��� fl� �, 2av�ch, I 4-7�( (/(/��
Person authorized b d execu etl vier of A ome or IC 6-1)42-0.7 Date rrlorlth,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.