HomeMy WebLinkAboutMortgage_Glomski (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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-`�'` FOR DEDUCTION FROM ASSESSED VALUATION p State Form 43709(R13/10-15)Presmbed by Department of Local Government Finance
1
• INSTRUCTIONS: File
To be filed in person or by mail.
o why
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 pmperf#R 1 I ?County Auditor
located on or before January 5 of the immediately succeeding calendar year. County Recorder
2) Mobile I Manufactured Homes not assessed as Real Property Must file with the County Auditor of the county
whem the property is located during the twelve(12)months before Mardi 31 of each year the deduction is 4 ghL• air—
See reverse side for additional instructions and qualifications. i( • fi nit
App;c�}jpwn(��buyer-see reverse side) ^ 1 /) GIBSON c,UU ` (Y AUDITOR
Taxing District number/legal descriptionlAV! `�'\�J1Aljr�,,,` Read number
la os-3oo-too , I40- Dal I�p Casco
Assessed vote of real property as of (Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid�of Is the applicant the sole
assessment dat,current year I assessment date,current year date!ligation legal or equitable owner?
(J(.�)�) ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with meoneoa Than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
❑Real Property ❑ AnnualyAssessed
__ _ Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller c, �jJ�� 'l '1 --
Address of mortgagee or contact seller(number ��V1� 1vK�) yf'a 10,2 41(x) w
(A RA L _
Name of assignee wother owner or holder of rtar J
Mead)
Address of assignee(number and street dry,scat I)Di-502
Does applicant own property in any If yes,what county? What Taxing District? I Has ma caeca been requested If yes,state amount of deduction
other on property for
in Indiana? Yes ❑No current year? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorders office(including any home equity line of credit 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 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/contract buyer of th aforementioned property on date application is filed.
Signature fun Date(month,day,year)
a
>rest(ad ress ofmalirant umber d street city,state,a d P code) nnt //��Persona orized by dory exeam f Attorney or by IC 6-t.t- 2-0.7 Date(month,day,year)
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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.