HomeMy WebLinkAboutMortgage_Humphrey (2) �,s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
IC.-- : FOR DEDUCTION FROM ASSESSED VALUATION
'- State Form 43709(R13/10-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS:
e
'lb be hied in person or by mail. r F
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought �L��LL 1g
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is un Auditor
located on or before January 5 of the immediately succeeding calendar year. unty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must Me with the County Auditor of the CouWB 2 404P
where the property 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. q y�!
App6.n' > or•• ,nr ,- > -see -- ' - -on reverse side) �tG:.9d(
9. L.- i r- . fit# li /IL,i4L .._1_ , GIBSON COUNTY"AUDIT. ;
Taxing District Key number I legal descri•I. 4 �� Recoumper Page number
aCO 3-35- 300 - poi , 8 — rd j /(0)
Assessed value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of 1 Is the appti antlhe sole
assessment date,anent year assessment date,current year date of application I legal or equitable owner?
103,cwD ❑ yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,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
Address of mortgagee or contract seller(number and sheet city,state. ZIP code)
Name of assignee or other owner or holder of mortgage
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 requested If yes,state amount of deduction
other county on property for
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 line of credit that is recorded in the county reoorde?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/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 I contract buyer of the aforementioned property on date application is filed.
Signature owners full name Date(month,day,year)
FWlx el appficant(number andstee• ,sta.---. dZIP cod
95-2o F_ qD 5
e on authorized by duly executed Power of Attomey or by IC 8-1.1-12-0.7 Date(month,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.