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HomeMy WebLinkAboutMortgage_Dilbeck (7) �, . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year t FOR DEDUCTION FROM ASSESSED VALUATION t. 1' State Form 43709(R13/10-15) �r--� �- Prescnbed by Department of Local Government Finance F.INSTRUCTIONS: lb 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 on is sought MAR ��7 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. 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the cou •un :ecorder• where the property is located during the twelve(12)months before March 31 of each year the deduction is --111 -417:lr:i See reverse side for additional instructions and qualifications. G I BSON COUNTY AUDITOR AP ' er orcontract buyer-see restrictions on reverse side) � �7 Q & 4F' 11 'i/.srJ ., CL /�I C -G/` Taxnng District Key number/legal description Record number Page number alp -10 - 33 - .2Do - on 5 39— b01,/ ?boll 415 9 ' Assessed value property 1 Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole assessment data,current year I assessment date,current year date of application legal or equitable owner? If no,what is his/her exact share of interest? If owned with someone other wan spouse, ❑Yes ❑ No use,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 6-1.1-7) Name of mortgagee or contract seller �r Address of mortgagee or contract seller C } (number aan`nd feet city,sate,and ZIP code) q Name of assignee or other owner or holder of mortgage q_, - -(5 c/ Ad,press of assignee(number and street,city,state,and ZIP code) D r a\`.ill✓r r N O.... /0 ^?... JrENE .33 - a - ► a, � a . a / i4L L< /�/)X�?. _ Does applicant own property in any If yes,what county? What Taxing District? Has this OS other eny Card NO. 57-I ? Yes ❑No currntear .. . A person is not entitled to this deduction unless the person has a balance on the person's mortgage l` ,` /!,0 l recorder's office(including any home equity line el of credit that is recorded in the county recorders ofl COUNTY AUDITOR Deduction approved in the amount of 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 correct and that the applicant is a resident of Indiana and owner I contract buyer of the aforementioned properly on date application is filed. ,_Signor rs full name) Date(month,day,year) �&) `!^a DS(num©buan �st/ag/te�/ LINE)r 476^Se Person authorized by duly executed Power of Attorney or by IC o-1 A-12.0.7 1' Date(month,day,year) Address of authorized person (number and street,city,slate,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. .