HomeMy WebLinkAboutMortgage_Cullivan e.. STATEMENT FOR OF DEDUCTION MORTGAGE FROM ASSESS OR CONTRACT ED VALUATION INDEBTEDNESS County Township Townshi Year
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:.° '^ State Form 43709(R13/10-15)
- Pre albed by Department of Local Government Finance g
INSTRUCTIONS: IF I q i1 4
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To be filed in person or by mail. ����LLLL //
Filing Oates' 1) Real Properly Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county whem the p r County Auditor
located on or before January 5 of the immediately succeeding calendar year r t tS 2
2) Mobile I Manufactured Homes not assessed as Rea/Properly:Must file with the CountyAuditor of the county County Recorder
where the property is located during the twelve(12)months before March 31 of each year the deducciv is sough
See reverse side for additional instructions and qualifications. -/N�
AppSrant(owner or contract buyer-see`zm' r`sonreverse.sbe) GIBBON COUNTY AUDITOR
Tom_ /flit/ number/legal description-/l/�•Q/Y`-piton Record number Page number
f o4-1L,, i-c 7- i4 -o4 - /4 - a.00 - 003. 6SY - o17 1-cd, 3t�
Assessed value of topeM as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract Indebtedness of Is the applicant the sole
assessment den, year assessment date,current year date of application legal or equitable owner?
/00, 000 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other Man 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 street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage \o, fin ^�
Address of assignee(number and street,till:state,and ZIP code) /�3�•
0-r 3 - I(0 - 1 - 9 I . b AC •
Does applicant own property in any IF yes,what county? What Taxing District? Has this deduction been requested I n
other county on property❑Yes ❑No current year? Yes 0 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,,ounty
recorder's office(including any home equity line of credit that is recorded in the courtly 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 Dare(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/contract buyer of the aforementioned property on date application is filed.
Signature(owners full name) Date(month,day,year)
,`C rips -,6,6 C
t, Fi resident address of applicant(number and street city,state,and ZIP code)
y) 34 r'o/fr7 77 5 E crawl-; sG t t N 76
Person authorized by duly executed Power of Attorney or by IC 6-I. -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 hall years and a fine not to exceed$10,000.