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HomeMy WebLinkAboutMortgage_Sievers • , . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year '=.f, FOR DEDUCTION FROM ASSESSED VALUATION l.� State Fonn 43709(R13/10-15) Cl--- Prescribed by Department of Local Government Finance J{MJ}D INSTRUCTIONS: - 1 IF Y .L TO 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 MAY 1® tgligitY Auditor located on or before January 5 of the immediatey succeeding calendar year. 2) Mobile I Manufactured Homes not assessed as Real Property Must file with the County Auditor of the county County Recorder where the properly is located during the twelve(12)months before March 31 of each year the deduction is sorr�i}f See reverse side for additional instructions and qualifications. Au �,/ r� �jlpp+ • or contract bvye% a on remise slie) +CJ le, GIBSON COUNTY AUDITOR Taxing District �� 1t Ie9I so-300-004. 13 3-Da 2 Remi d n ' number Clole Assessed value of real property as of Mortgage/Contract indebtedness unpaU Mortgage/Contract indebtedness unpaid as r the applicant the assessment date,current year assessment date,current year date of appiiration) ` I legal or equitable owner? Y ©� l//CUJlC7/l I ❑ Yes ❑ No If no,what is his I her exact sham of interest? If owned with someone other than spouse,indicate with whom If name on record is afferent than that of appli ant'vWip}e Pr Is the property in question:Annually Assessed• ❑ Real Property ❑ Annualiy Assessed 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) Name of assignee or other owner or holder of mortgage . •r. 6rock aSever,S 4 • Address of assignee(number and street dry,state,and ZIP code) ty,r, '1l" L.. iCV°-v S \C . Does applicant own property in any If yes,what county? What Tani C` ? V G 1`--1 \0 O C) state amount of deduction other county in Indiana? ❑Yes 0 No A person is not entitled to this deduction unless the person has a balan a 1 ` — ' it is recorded in the county recorder's office(including any home equity line of credit that is record[ _ )--l- "I ieducuion. COUNTY AUDITOR Deduction approved in the amount of 20 20 20 20 20 20 20 Signature of County Auditor croupy • Date(month,day,year) 1/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 :-.-.•ni-r of the aforementioned property on date application is tiled. — Sig -�n err :r e) Date .day,year) Full r •�7 ...:At m sLeat,aly,state,�(rrWJP �_% Person authorized by duly executed of Attorney or by IC 61.1-12-0.7 Date(month,day,year) Address of authorized person (number and street city,state,and ZIP code) The penal ties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.