HomeMy WebLinkAboutMortgage_Rodgers (2) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
_ -- ' State Fonn 43709(R13/10-15) - •
Presented by Department of Local Government Finance ,
iin Mal 1 D
INSTRUCTIONS: -
lb be filed in person or by mad. Form Sled with:
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for whkh the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is MAY 214 €@4gty Auditor
located on or before January 5 of the immediately succeeding calendar year.
2
0) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county. County Recorder
where the property is located during the twelve(12)months before March 31 of each year the deduction is -•
See reverse side for additional instructions and qualifications. if ' 4111711:
GIBSON COUNTY AUDITOR
APPga
or contract buyer-see restrictions
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Taxing Fray number/legal tl 1\-�,– 4\\YJ• Record number Page number
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Amassed value of real property as of Mortgage!Contract indebtedness unpaid as of Mortgage!Contract indebtedness unpaid as of Is the applicant the sole
assessment data,current year assessment date,current year' 1 date of application legal or equitable water?
Co 1. y1 [ Yes ❑ No
If no,what is his t her exact share of interest? If owned with someone other than spouse,indicate with whom '
If name on records different than that of applicant,indicate below-. - s the property in question:Annually Assessed
Property ❑ Annually Assessed
• Mobs Flare(IC 6-1.1-7)
Na mortgagee or contract seller
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Address of mortgagee or contract seller(number and street city,state,and ZIP code) -— - —_
Name of assignee or other owner or holder of mortgage
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Address of assignee(number and steet,city,state,and LP code) •-...l.... .'''.)....
Does applicant own property o any If yes,what county? What Taxing District? a C a f r(] NO O rho lion
other county a
in Indiana? ❑Yes ❑No current year ,_, .. •••-•..
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is rewrw....._._ 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 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 I contract buyer of the aforementioned property on date application is filed.
Signature e( full name • Date(month,day,year)
r�
resident it
ded address of applicant(number and street city state,and ZIP code)
(`'(n'
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Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Data(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.