HomeMy WebLinkAboutMortgage_Morgan (2) „. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court Township Year
''t t FOR DEDUCTION FROM ASSESSED VALUATION P
�', State Fonn 43709(R13/10-15)
Presorted by Department of Local Government Finance H , J
INSTRUCTIONS: gK
To be filed in person or by mail. , . led with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought MAR 31
LU. I
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly is (J County Auditor
located on or before January 5 of the immediately succeeding calendar year. Recorder•2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the 1ty
where the property is located during the twelve(12)months before March 31 of each year the deduction
See reverse side for additional instructions and qualifications. G I BSO N COUNTY AUDITOR
Applicant(owner or contract b�uyyeer'-mssee�� on reverse side
T Distri l I\ eeyhu /legal description Record nu Page n r
d, > U D --n2ab- tMaa . 1-1 (o-aO 1m/he/c/1 V?
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness ess unpaid as of 'ls the applicant csdle
assessment date,current year assessment date,current year date of application legal orpquitabte owner?
VV p t)ri r>p rives 0 No
If no,what is his/her exact share of interest? If wined with someone other than spouse,indicate with whom
If name on record is different than that of applicant indicate below: I the property in question:Annually Assessed
Property ❑ AnnuauyAssessed
• Mobile Home(IC 6-11-7)
Name mortgagee or contract seller •
L 2—\---r(u ire T A.[ r S`a.o
Address of mortgagee or contact seller(number and 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)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county , property for {,r�
in Indiana? Yes f`�'(®'o current year? ❑Yes tlo
A person is not entitled to IN 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 coedit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of.
20_ 20 20 20 20 20 20
Signature of County Auditor o 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 buye •f the aforementioned property on date application is filed.
Signature(• r i TVi4,. e) D Date(month,day,year)
% i.
Futident a” pphcant(number and street city state,and ZIP code)
to /72 r Cos0.4-(, �4 I - C;4i 4766c)
Person authorized by duly executed Power of Attorney or by IC 6-11-12-0.7 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. •