HomeMy WebLinkAboutMortgage_Cunningham (2) tea,. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.r,_, .I„ FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: �.e�_��p��
To be filed in person or by mail. I/ �����p� with:
Filing Oates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the pro rt§is3 0 201 g County Auditor
beefed on or before January 5 of the immediatety succeeding calendar year. Hli County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve f 12)months March 31 of each year the dd • is sough
See reverse side for additional instructions • afi
Apr (ownerormrmact u -"j� side) �� GIBSO COUNTY AUDITOR
Q
Ta cing D" " Key nu :_ /legal description Record number Page number
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Assessed of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
0 0 D ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse ,thdirate with whom
If name on record is different than that of applicant,indicate below Is the property in question:Annually Assessed
Ly�Keat Property 0 Annually Assessed
Moblle Home(IC 6-1.1-7)
Name of mortgagee or contract seller �T
Address of mortgagee or contract seller(nummb anti street,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) -
I r -sue p F 13 - 3 - 0 I , a -» 7 ,¢( __.__
Does applicant awn property in any If yes,what county? What Taxing District? ton
other county . C
in Indiana? D Yes D No u �'•v.v.1��\N-c....rz4 A person is not enfitled to this deduction unless the person has a balance on the person' 'lL' 0Acc_�r county
recorders office including any home equity line of credit that is recorded in the county n 0 :�
COUNTY AUDIT( a0 �, _ 6° S/'3 ,-N
Deduction approved in the amount of 4 3
20 20 20 _ 20 `� 1� ab. 6O
Signature of County Auditor County I 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.
(Sig�l ow e) Date(month,day,year)
,\_ address of applicant(nu and city.slate,and ZIP crod
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Pert6n authorized by duty executed Power of Attomey or by IC 8-1.1-12-0.7 Date(month,day.year)
Address of authorized person (number and street city,state,and ZIP code)
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The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. -.