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HomeMy WebLinkAboutMortgage_Mutchman • egi-1,,w., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year t. - FOR DEDUCTION FROM ASSESSED VALUATION m �', State Fonn 43709(R13/10-15) Prescribed by DepartmeM of Local Government Finance �j eI)a D INSTRUCTIONS: AAI/' 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 Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is v AA--BB 6ouniQ idor located on or before January 5 of the immediately succeeding calendar year. 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county County Recorder where the pmpedy is located during the Metre(12)months before March 31 of each year the deduction is sought See reverse side for additional instructions and qualifications. GIBOON COUNTY AUDITOR. Applicant(owner tra buyer-see restrictions on reverse side) _ Taxing District Key numbelerr///legal description �]/� �[) /'y�, Record number Page number Assessed value of real property as of Mongage/Co indebtedness C/�/©of Mortgage t t 75str(� unpaid as of Is the applicant the sole' . assessment data curredyear assessment date,rent year date of ap/pl/�,'irat( nn .� legal or equitable owner? If no,what is his/her exact share of interest? If wined with somedne o0fr1 Nan ❑ Yes ❑ No spouse,indicate with whom If name on record is different than that of appfrcant,indicate belo(w/(��� \J Is the property in question:Annually Assessed • J n U /3 ❑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 mortl C7/I t 0 /L — 34, 0 9 Drawer tNO. Address of assignee(number and street city,state ••••••..-.......,, Does applicant own property in any If yes,what Card NO. on been requested tf yes,state amount of deduction other county ... in Indiana? ❑Yes ❑ ................. NO ❑Yes 0 N A person is not entitled to this deduction unit 1 1/4,-/ contract indebtedness that is recorded in the county recorder's office('including any home equity O el — /. /(y - .)that is the basis for the deduction. 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 coned and that the applicant is a resident of Indiana and owner I contract buyer of the aforementioned property on date application is filed. re(ow0ers to e) . Date(month,day,year) /-/f)yY_I -j{(�Cl-CLH'ILI.d 7 es" ddress of applicantrQumbe rand street city,state,a P e) o(02 9nos �'�' 4160 Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0. 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 510,000.