HomeMy WebLinkAboutMortgage_McKinney STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION County Township Year
State Fonn 43709(R13/10.15)
Ptescrbed by Department of Local Government Finance DULY ENTERED FOR TAXAT ON
INSTRUCTIONS: )<I final ag5rep ( for transfer
To be filed in person or by mail. ' of r,,,III rkd with
Filing Dates' 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought ttvvAp
Must be filed or postmarked with the County Auditor or County Recorder of the% ITT r i pem'i i MI Co unit editor
located on or before January 5 of the immediately succeeding calendar year it 2) Mobffe I Manufactured Homes not assessed as Real Property:Must fie with the County A . '/ e •rIn" ❑ Gpiygy der
when:the property is located during the twelve(12)months before Mardi 31 of e year t -sought
See reverse side for additional instructions and qualifications.
Applicant(owner or contract bsyert f-re' •:.I onneverse side) GIBBON COUNTY AUDITOR Page numter
Tag (0 — 1 LI-1 8--1D IIYVALIT Record 139—00/2 (nil r 1097
Assessed value of net property as of Mortgage/Contract indebtedness unpaid as of Mortgage/ContMc1 indebtedness unpaid as of Is the applicant the sole
assessment dae,current year assessment date,current year date of�applcation legal or equitable owner?
Y JI r'.7!/ ❑ yes ❑ No
If rn,what is his I her exact sham 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 ❑ AnnualyAssessed
1 py��� �1 �, . . Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller I / / Y ./V /lhWy'
Address of mortgagee oY"_/ seller(number),d .-. city,state,and 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 If yes,what county? - - ---"--tad If yes,state amount of deduction
other county
in Indiana? ❑Yes 0 No T ar iNc
A person is not entitled to this deduction unless the pars M itedness that is recorded in the county
recorder's office(including any home equity line of aedi Alai-1/4)6Y( / 7 asis for the deduction.
Deduction approved in the amount of -
20 20 20 20 20 I 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 3- futIn. e) I �\ Date(month,day,year)
J - �/Aj `J7 03—/ s_ 2dl7
•ent add '- of applicant(number and street city,state,and ZIP code)
Person.uthodz,-•by duty 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.
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