HomeMy WebLinkAboutMortgage_Miller (18) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
'fix•,.:. FOR DEDUCTION FROM ASSESSED VALUATION
-, State Form 43709(R13/10-15)
Prescribed by Department of Local Government Finance
Mt
INSiRIKRONS: _( :
To be filed in person or by mail "
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 Auddor or County Recorder of the county where the properly is FEB •i ❑2 UI b 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 the county
where the property is located during the twelve(12)months before Mardi 31 of each year the deduction is sours• .
See reverse side((((((���d�d�d'�dd ittonal instructions and qualifications. dI l' "lennit
AppSnnt(ownero awyer-see rnspigdonsi rereryeside� n GIBBON COUNTY AUDITOR
Taxing DisVict J/C` `+=�0 n l O�- 001— 1 s33 - oaa,t Record number Pagn�mber
assessment value�M real as of Mortgage/Contra,ld indebtedness unpaid as of Mortgage/Cor�act indebtedness unpaid as of Is the applicant the sole •
year assessment data,curri eaL r—Yf) cat-. . _. r legal or equitable owner?
rj
r '...j7rj11/144 0 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 afferent than that of applicant,indicate 6elpvr. Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 61.1-7)
Name of mortgagee or contract se6
Drawer tNrO....Q ( ).
Address of mortgagee or contract s
Card NO.
Name of assignee or other owner •••.... / n
Address of assignee(number ant 1—n-(7_ I ( 3c2, 00)
Does applicant own property in any If yes,what county? vvnar ta....a_.__. •this deduction been requested If yes,state amount of deduction
other county on property tw
in Indiana? ❑Yes ❑No I current prop 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(induding 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 ot.
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.
Sig a(owners e) Date(month,day,year)
F t dress ben and sweet,city.state.and LP
8 r•tM,N&4 lb/0
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 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 hall years and a fine not to exceed S10,000. .