HomeMy WebLinkAboutMortgage_Stallings } STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
.t f._ , • FOR DEDUCTION FROM ASSESSED VALUATION
' State Form 43709(R131 10-15)
�- Prescribed by Department of Local Government Finance _ . ea
INSTRUCTIONS: (e t
1..
To be filed in perm or by mail. Form filed with:
Filing Dates: 1) Real Properly Must be completed and dated in the calendar year for which the deduction is sought rr--,,��
Must be filed or posbnarked with the County Auditor or County Recorder of the county where the property i MAR LK my 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 Me with the County Auditor of the cou bb
where the properly is located during the twelve(12)months before March 31 of each year the deduction is -:,T'::; .jrmft
See reverse side for additional instructions and qualifications. GIBSON COUNTY
Applicant ;._ contra-wryer-see re- -,•ib• .-verse side) AUDITOR
.4t// ///. i 02Oai • • r� _ _L//Q
T-• %LT' r Anus t legal descnpbon Record number Page number
,�a (2 _ ,,-6,-,,,,,,,. ,, ,- ,,7 C �D/ 7
Assessed value of real p••- as' Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole •
assessment data,ament year assessment date,arrant year date of application . / legal or equitable coiner?
JC-o? ins ❑ Yes ❑ No
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 property in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Rome(IC 6-1.1-7)
Name of mortgagee or contract seller �t ,�
/
Address of mortgagee or contact seller(number and street city,sate.and code)
Name of assignee or other owner or holder of e ' �srTrY
� a-i/ a V73A6eex5�.�a
Address of assignee(number and street city,state-and ZIP code)
Does county applicant own property in any If yes,what county? What Taxing District? deduction been request2...47(4t.
d If yes,state amount N deduction
in Indiana? Dyes ❑No current 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(including 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. - �-.n[ / _-
Drawer NO `9C 7- 20 20 20 20
Signal 3
_
County -Date(month,day,year)
Card NO.
I 1% uegoing information is true and correct and that the applicant is a resident of Indiana and
owl - . . - application is filed.
,/ n lull
^t_name VA t in Date(month.day,year)id j`•F,ruus t address+s of appliicari tuber and street,city,state,and ZIP code)
I ! !5 uO 15O N Pr-Pr TINJ ) Ilp'UO
Person authorized by duly executed of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street dry,state,and ZIP code)
The penalties for pei uty can include imprisonment up to two and a hall years and a fine not to exceed trawl =