HomeMy WebLinkAboutMortgage_Ortiz STATEMENT FOR OF DEDUCTION MORTFROM GAGE ASSESS OR CONTRACT ED VALUATION INDEBTEDNESS County Township Year
' State Form 43709(R13/10-15)
`--" Presalbed by Department of Local Government Finance
INSTRUCTIONS:
To be filed in person or by mail. Form filed with:
Filing Dates 1) Real Properly.Must be completed and dated in the calendar year for which the deduction is sought MAY 0 2 2p.�7
Must be filed orpost narked with the County Auditor or County Recorder of the county where the property is C-7 County Auditor
located on or before January 5 of the immediately succeeding calendar year. • County Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the . nty.
where the property is located during the twelve(12)months before March 31 of each year the deduction rl=.n.r inviting:
See reverse side for additional instructions and qualifications. GIBSON COUNTY Al I I1ITnR
Appfrant( er or contract buyer-see restriRs on reverse side)
Taring District Key number I legal description Record n Page m r
� - ID Or- 02o3- oo • ga-ode
Assessed value of real property as of mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of fs the applicant the sole
assessment date,aurent year assessment date,current year date of application legal or equitable owner?
0lr ❑ Yes ❑ No
If no.what is his/her exact share of interest? If owned with so eone other than spouse,indicate with whom
If name on record is afferent 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 /1
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) •
•
Name of assignee or other owner or holder of mortgage
s
Address ofa nee number and street Er ors*7 Or* \Z. N (�
assignee( city,state,and LP aide)
Roy, C1. r,—I'
Does applicant own property in any If yes,what county? What Tat state amount of deduction
other in Indiana? El yes ❑No aoc- - 61S - �,— '
A person is not entitled to this deduction unless the person has a bale. it is recorded in the county
recorder's office(including any home equity line of credit that is won: A' 100 t S c t a. a seduction.
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Audltor 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 the aforementioned property on date application is filed.
Signatur wnett full e) O Date(month,day,year)
Full resident address of applicant(number and sorest city state,and ZIP code)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 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.