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HomeMy WebLinkAboutMortgage_Comer sT'. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year f_ FOR DEDUCTION FROM ASSESSED VALUATION '•'s State Form 43709(R13/1615) S i Prescribed by Department of Local Government Finance F I L EAD 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 ����RR tt,,1��.,, Must be filed or postmarked with the County Audrtor or County Recorder of the county where the propeyt}ts3 21 L_I County Auditor located on or before January 5 of the immediately succeeding calendar year. • County Recorder 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of th= ;aunty where the property is located during the twelve(12)months before March 31 of each year the deduct).�� p; �. See m side for additional instructions and qualifications. •_f erw...rrea• I o re GIBSON COI INTY AUDITOR Taxing D'. :• • a tuber/lega a�phon Record n`i tuber Page number o - Id—h ©b -304- 001. 33a-Od1 no• 991 3 Assessed vabe of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the assessment date,and year assessment dab,current year date of, legal or emii/al'de oowner?1/O_S t CfrO ❑ 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 ❑ AnnuallyAssessed Mobile Hone(IC 6-1.1-7) Name of mortgagee or contract seller V Address of mortgagee or contract seller(number and abet;city,state,and ZIP code) Name of assignee or other owner or holder of mortgage Address of assignee(number and street,city,s-" r Drawer \O.•• '' Does applicant own property in any If yes,wt 1 •,,,•- a been requested If yes,state amount of deduction other county �• . • in Indiana? ❑ 1� Card Yes ❑No ))�,, 11 • �� ]Yes ❑No A person is not entitled to this deduction un `W(D1 - ntract indebtedness that is recorded in the county recorders office(including any home equip Fog .P hat is the basis for the deduction. Deduction approved in the amount of: WITS,/ ll-e- Tecdc )eC ey1,+ urim -r-. 20 20 20 20 20 20 20 Signature of County Auditor County • Date(month,day,year) 1/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 afor-• -ntioned property on date application is filed. Signature • •- s full name) ,' Date(month,day,year) •�r d address applicant •m•- and street,City,state.an:-code) Peacin authorized by dub exeat of Attu ey or C 61.1-12-0.p f� L/7(70 Date(month,day,year) Address offaauthorizteed,`/(person (number and street city,state,and ZIP code) \�\{L►'-\ _ _ _ _ 1 The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000. _ _ .- _ . _. _