HomeMy WebLinkAboutMortgage_Richardson (2) (sj STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� County Township Year
.-, FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13110-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: File
To be filed in person or by mail.
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 propertx{s r1 ounty Auditor
located on or before January 5 of the immediately succeeding calendar year. MAY 2 bounty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where property is ions and qual the twelve(12)months before March 31 of each year the deduction is ht.
See reverse side for additional the ro Ieatmstlo a and ring t he twel
Applicant(o or contract buyer-see re on terse side)
1G`aP� ( \ IICe GIBBON COUNTY AUDITOR
Taring District Key number/legal area Lion /� /�
p u0��1 "d 0� ��—/,��// I
Record number Page number
P;—N�:SG )-3 ,a, 5-7✓e , aol'l - a155
Assessed value property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applcom the sole current assessment year assessment date,orient year date of application legal or equity a owner?
)C?& 7C� es ID No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the...propeny in question:Annually Assessed
Real Property ❑ Annually Assessed
Name ongagee o�seller Mobile Home(IC 6-1.1-7)
Nam
hirrte.r{tf rnnr -O. 40-I-pct& On_
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or bolder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own properly in a If yes.what county? What Taxing District? Has this deduction been requested
other county on properly for e9 If yes,state amount of deduction
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
recorder's 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 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 I contract buyer of the aforementioned property on date application is filed.
Signature(awnefs lutl/'mfi n • Date(month,day,year)
�Vf s�i//2o/7
ul resident address of applicant(number and street,city.star and ZIP code)
_'1'd yS 5 se In �MjPPRP/li, " I AI 7 IPbAir
Person authorized by duly executed Power of Attorney or by IC 0-1.1-12-0.7 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 510,000.
III .