HomeMy WebLinkAboutMortgage_Powers a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
a t'''- FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15)
Prescribed by Department of Local Government Finance
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INSTRUCTIONS:
lb 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 soug(4Ay 1 20 201;
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property it ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year
2) Mobile/Manufactured Homes not assessed as Real Property Must file with the CounfyAuditor a cou ❑ County Recerder
where the property is located during the twehe(12)months before March 31 of each year the
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
App6 t( veer or contract buyer- / arm re At p
T ' Datrict Key number/legal
description options Recad number Page number
d✓o - /3 -a8 -boo -coo . 685-coy • / aoo5
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as f Is the applicant the sole
assessment date,current year assessment date,current year date of applxation legal or equitable owner?
45 eaD 0 Yes 0 No
If no,what is his/her exact store of interest? If owned with someone other than spouse,indicate with whom
If name on record is ddferent 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 —
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) /�//n n /�_
Name of assignee or other owner or holder of mortgage �`�>� 1� "' �. /" `
Address of assignee(number and street,ctty,state,and ZIP code) 711P—
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Does applicant awn property in any If yes,what county? al Taxing District? I
Mal /1-Cl
IO5 won
other county on prow.,
in Indiana? ❑Yes ❑No current year? L. •-. -
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness 3 county
recorder's office(inducting any borne equity fine of credit that is recorded in the county recorders office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount at
20 20 20 20 20 20 20
Signatre 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/contact buyer of the aforementioned property on date application is tiled.
\ Sig uutiname) Date(month,day,year)
-
)(Full resident address of applicant(number and street,city,state,and ZIP code)
7 984, E so A (9 ri Y76GD
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,may,state,and ZIP ode)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.
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