HomeMy WebLinkAboutMortgage_Gilmore ,. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
•Pr FOR DEDUCTION FROM ASSESSED VALUATION
:.� < State Form 43709(R13110-15)
� Presaibed by Department of Local Government Finance
INSTRUCTIONS:
To be filed in person or by mail. �IT()r:
Filing Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought g
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is County ditor
located on or before January 5 of the immediately succeeding calendar year IA ty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the CountyAuditor of the county" Q
where the properly is located during the twelve(12)months before Mardi 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications. Y^ �.
AppWowner
C& wkats V on ise side) s ./�✓`�' S. P �
Kev GIBBON COUNTY AUDITOR
Taxing D G `'119- 2 -egat description IW-000 . D / V— Val. Record
,.2 number Page
1 1 number
Tcam(
Assessed value of real property as of a/(u•/• Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole •
assessment date,ament year assessment date,current year date of application legal or equitable owner?
1 LC g'Or?) ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than sprv/se,indicate with whom
If name on record is different than that of applicant,iMicate below: Is the property in question:Annually Assessed
. ❑ Real Property ❑ Annually Assessed
' - - Mobile Horne(IC 6-1.1-7)
Name of mortgagee or contract seller IR I CAI A .n
Address of mortgagee or contact seller(number nil sheet city,state,and ZIP code) ( lE L.L5Sp S GIL m o Rf
Name of assignee or other owner or holder of mortgage I 1 — 1 goi
Address of assignee(number and street,city state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requeww. I.., _,. unt of deduction
other county on property far
in Indiana? ❑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 fine 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 20 20 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.
Signature D ) Dam(month,day,year)
Fu ent dress of applipM(num and street city,state,and ZIP code)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-03 Date(month,day,year)
•
Address of authorized person (number and street cily,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.