HomeMy WebLinkAboutMortgage_Hudson eaSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Fonn 43709(R13 l 10-15) a_
Presaled by Department of Local Government Finance t 1�L-+
INSTRUCTIONS: ' Ile tvlr
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 �-T
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property CEEB tea[Uunty Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the coups County Recorder
where the property is located during the twelve(12)months before March 31 of each year the deduction is -. ,1 t . ci
See reverse side for additional instructions and qualifications. I'ml Pr
Applicant(ow„a,orr,,, adyer-see 'y reverse if H GIBSON COUNTY AUDITOR
✓'C�ll (-1i14.1(i r► • ` / / tea'$,[ Cb��
Taxing District • e,6—'2-16— i oo - OCO.Qa 3-Dal Record rWIV r Je�m I s
Assessed value of real property as of Mortgage!Contract indebtedness unpaid as of Mortgage!Contract indebtedness unpaid as of Is the applicant the sole
assessment dart;current year assessment date,current year date application legal or equitable owner?
I owner?f14Ott ❑ Yes ❑ No
If no,what is his I her exact share of interest? It owned with someone other than spouse.indicate with whom
If name on record is different than that of applicant,indicate bebr. Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
• Fdoble Home(IC 6-1.1-7)
Name of mortgagee or contrail seller 3_e}6_,
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
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Name of assignee or other owner or holder of mortgage /
Address of assignee(number and street city,state,a f ud� Gar j L/1odi th&
Does applicant own property in any If yes,what cc 'fUCn f / T .�,/7�- 1� n requested If yes,state amount of deduction
other county S UI II e 1 e(�ci�.r "o A—'in Indiana? ❑Yes ❑No m ❑No A person is not entitled to this deduction unless R.r <-710 t�_ 3_, t-C y ct indebtedness that is recorded in the county
recorder's office(including any home equity lint r✓V 9 �P 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(contract buyer of the aforementioned property on date application is filed.
Signature( eras MI name) Date(month,day,year)
ddress ss a. v ii.9-D,L.y
F ent ddress of pliant tuber an0 ,city,state,and ZIP e)
35 ► i Pikw ��7o
P n authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,yearn)
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Address of authorized person (number and sheet 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.
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