HomeMy WebLinkAboutMortgage_Bree O STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Fonn 43709(R13/10-15)
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Presanbed by Department of Local Government Finance
INSTRUCTIONS:
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To be filed in person or by mail. � �F with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sou YY��
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. fit,��pp
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the EtlG))ty 2,0 Z County Recorder
where the cal instructions s o a dtqua!the ionWe(12)months before March 31 of each year the deduction is sought
See reverse side kw additional and qualifications. •
Applicant(owner or contract•Z--/ see restrictions on re rse TY AUDITOR
• /LLCM G%BSON COUN
Taring District umber/legal description Revd n num�er
14.44 -Io4-000. 10-co ao
Assessed value of real property as of I Mortgage e Contract indebtedness unpaid as of Mortgage/Contract• ebtedness unpaid as of Is the applicant the sole •
assessment date,current year assessment date,current year date of as plicaD 1.5:, legal or equitable owner?
Lit ((OO���i Yes ❑ No
If no what is his/her exact /— 6 l//g//f� / I with someone other than spouse,indicate with whom
If name on record is differen /� J ! V Is the property in question:Annually Assessed
Q�r� +��� �S ////1 O Real Property ❑ Motile yAssessed
–,jO Mobile Home((C 6-1.1-7)
Name of mortgagee or cant n
Address of mortgagee or co /j 0 – 950
Name of assignee or other r
Address of assignee(numb 4 4 l/20 S (2-2
Does applicant own proper[ Has this deduction been requested If yes,state amount of deduction
��a? ❑Yes coun f?o ❑Yes El No ,
A person is not entitled tc ?s mortgage or contract indebtedness that is recorded in the county
recorder's office(includin ecorder's Max)that is the basis for the deduction.
)R
Deduction approved in the
20 20 20 20
Signature of County Auditor • Date(month,day,year) •
Da
I!We ce 'I. f•: the true and correct and that the applicant is a resident of Indiana and
owner •uye
Signora el- I neml Date(month,day,year)
• 3-ao--j
F –'.•ent address of app
Person authorized by duty executed Power of Nome;or 61.1-12-0.7 V Date(month,day,year)
Address of authorized person (number and street drys 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.