HomeMy WebLinkAboutMortgage_Karges a: STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
el FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15)
'---=- Prescnbed by Department of Local Government Finance
INSTRUCTIONS: Fri
To be filed in person or by mail �� o .�7tr
Filing Oates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sough ���LLL.JJJ
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year A���ft�0R s ED ED./County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the cdFhfiy`
when the properly is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or conibuyer rer'm"ctions on reverse/D -
'Q(1! GIBSON COUNTY AUDITOR
Taring District ni{n /t r/i� r co 4 ( 716a? Record n' r Page numba�
Assessed value of real property as of O( Mortgage/Contract tad ness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appl(1/cantt the sole
assessment dap,current year assessment date,current year date,of apRli ation_ legal or equitable owner?
G S DAZE) ❑ 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 ❑ Annually Assessed
Mobile Home(IC 61.1-7)
Name of mortgagee or contract seller /7•
t Fe., , `
Address of mortgagee or contract seller(number and street,raty,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
-a,0 \1 — ‘S ZS
Address of assignee(number and street,city,state and ZIP I
1 \
Does applicant own property in any If yes,what county? O'(``� `p\ - ^S fed If yes,state amount of deduction
other county
in Indiana? ❑Yes ❑No No ,
A person is not entitled to this deduction unless the per. \ ; { - tedness that is recorded in the county
recorder's office(including any home equity line of rxed -It 1 'sis for the deduction.
Deduction approved in the amount of: U,S ` 3y^ a CI
20 20 20_ 20 20
'- \a-\1
Signature of County Auditor Date(month,day,year)
I/We certify under the penalty of perjury that the abo pplicant is a resident of Indiana and
owner I contract buyer of the aforementioned proper()
nature(owner's fire Dap(inuntlr,day,year)
Ko/e6on �f
u9 • ent address of applicant( tier and street,city,state,and ZIP code)
4365 S 3cc E P(9 -Ivo 1141 III&70
n authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 f 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.