HomeMy WebLinkAboutMortgage_Mefford STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
' . FOR DEDUCTION FROM ASSESSED VALUATION
_; State Form 43709(R13/10-15)
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�- Presrnbed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. d.�j Form filed with:
Filing Dates 1) Real Property: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�rp�t4g p/gperty is unty Auditor
located on or before January 5 of the immediately succeeding calendar year. I L U l f ❑ 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 hvelve(12)months before March 31 of a the dada on is sought
See reverse side for additional instructions and qualifications. . f
Applicant(own contrast see res7 onnmve ^Q GIBSON COUNTY AUDITOR
T Q - –�d(P ' lsLlSI-Ia3 -COD. SS9 _o 17 j Page j `
Assessed value of property as of Mortgage I Contras indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of th the applicant the sole
assessment dabs, year assesSl+tCrr1 dpfe.purpp date of app6cafion legal or equ[table owner?
UU ❑ Yes 0 N
If no,what is his I 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 ❑ AnnuaflyAssessed
' Mobile Home(IC 6-11-7)
Name of mortgagee or contract seller PIAr
Address of mortgagee or contract seller(number and sheet city, ,arid 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 I If yes,what county? !What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county
in Indiana? ❑Yes Dun._ --— - — currenntt year? ❑Yes ❑No _
A person is not entitled to � r At) 's mortgage or contract indebtedness that is recorded in the county
recorder's office(indudin5 /Y] /' v (, fcorder's office)that is the basis for the deduction.
I A,,n�IOM R
Deduction approved in the an 1 1- 6019
20 � __ 20 20 20
I1
Signature of ry ud'r',w / /J County I , Date(mordb,day yg/ar)/7
I f We ce under the penalty of perjury that the above andfOregoing 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.
S(gnature(owners name) / Date(month,day,year)
P L'L� 7 �/
dl resident ad of applicant caber and street dls t ,and ZIP code) _
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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 half years and a fine not to exceed$10,000.