HomeMy WebLinkAboutMortgage_Watt (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
. Y State Form 43709(R13110-15)
Prescribed by Department of Local Government Finance -- - •
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 is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is APR 1� niWib Auditor
located on or before January 5 of the immediately succeeding calendar year. 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(12)months before March 31 of each year the deduction is so 1=411
See is rse side for additional instructions and qualfrc afions. ��(� ,, .gfl h
(owner ar contract r-see re on reverse side) GIBSON t:UUNTY AUDITOR
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Assessed value 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,oared year assessment date,current year date of a ication legal or equitable owner?
J\ ❑ Yes 0 N
If no,what is his/her exact share of interest? If owned with someone er than spouse,indicate with whom
If name on record is different than that of applicant,indicate bebw Is the property in question:Annually Assessed
❑Real Property ❑ Annually Assessed
• Mobile Home(IC 6r1.1-7) .
Name of mortgagee a contract seller
Address of mortgagee or contract seller(number and street,city,state,and LP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street dry,slate,and ZIP code)
Does applicant own property in any If yes,what a U _ ' C O C) in been requested If yes,state amount of deduction
other county J
in Indiana? ❑Yes ❑No _ ❑Yes ❑No _
A person is not entitled to this deduction unle `)Q S J ,°F S u-Y.N t.f C t P . ontract indebtedness that is recorded in the county
recorder's office(including any home equity I ( `jck 40 co A •that is the basis for the deduction.
Deduction approved in the amount of: 33' t 5O
il- 1k- 11
20 20 2u I ga 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 1 contract buyer of the aforementioned property on date application is filed.
72„irec( name) Date(month,day,year)
d' dreJFSfign t(n and sheet e1p53tafe,and LP code to 2G 7D
Person authorized d y executed Power of Attorney or by/y/I,C`6-11.1-12.0.7 �uy,/-� Date(month,day,year)
Address of authorized person (number and street dry,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.