HomeMy WebLinkAboutMortgage_Graves 4c . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
\'. State Form 43709(R13/10-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: • F,
To be filed in person or by mail m •��y '
Filing Dates' 1) Real Properly.Must be completed and dated in the calendar year for which the deduction is sou P
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is County Auditor
boated on or before January 5 of the irmnediatry succeeding calendar year. t,�'
2) Mobile/Manufactured Homes not assessed as Real Property:Must We with the County Auditor of the aauryO 5 County Recorder
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Appfic-ant(owner oroonbaa buyer-see restrictions on reverse side)
5 0.5°c r i (Y1 c,r k G rq. e�S GIBSON COUNTY AUDITOR
Taxing District Key number/legal desaiplion Record number umber
ak- ia- b -Ioo -coo. ao8-oat I T'%
Assessed value of real property as Mortgage!Contras indebtedness unpaid as of Mortgage I indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
❑ Yes ❑ No
It nor,what is his I her exact share of interest? If owned with someone other than spouse,indicate with wham
If name on record is different than that of applicant,indicate ate bebvr. - Is the property in question:Annually Assessed
G- V< S� ,/ ❑ Real Property ❑ AnnuatyAssessed
l • a't ra. Mobge Home(1C 61.1-7)
Ndmne of mortgagee•=I 1 \�
r � � r
Address of mortgagee or contract seller(num..- •street dry,state,and ZIP code)
Name of assignee or oiler owner or holder of mortgage
Address of assignee(number and street city,state,and VP code)
Does applicant own property in any If yes,what tartly? What Taxing District? Has this deduction been requested If yes,state amount Ndeduction
other county on property for
N m
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 recorders 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/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:
Signature(owner's full name) Date(•month,day,year)
5— 3o
FW address a applicant(number and dty,state,and P code)
a s ISb E 9,� 4 )6 ?
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 sheet 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.
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