HomeMy WebLinkAboutMortgage_Morgan (5) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS county Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
•
�' swp Fonn 43709(R13/10-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: Ma
To be filed in person or by mad.
Fang Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be led or postmarked with the County Auditor or County Recorder of the county where the property is JUN 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 County Auditor of the county My Recorder
where the property is faceted during the twelve(12)months before March 31 of each year the deduction is sough
See reverse side for additional instructions and qualifications.
Applicant(ogergruf rontrartsee runs re / ^ ,� it '4
\ �`v /QI` 1 ,/ ` GIBSON COUNTY AUDITOR
Taxing 4
• fle = 11-4 ?— ao tieC%i�L3a?,oat `? Page
Assessed value d real property as of Mortgage/Contract indebtedness unpaid as of - Mortgage/Contract indebtedness unpaid as of Is the apeicard the sole
aribe:u,rr,ad dab,=rent year .„ILO d date,amend year date of application legal or equitable twiner?
L001652) ❑ Yes ❑ No
If to,what is his/her exact sham of interest? If owned with someone other than contra.,indicate with whom
If name on rend is different than that of applicant,indicate below: _ I re'he property in question:AnnuatyAssessed
(�� c-f�-� n,r� Read Property ❑ Annually Assessed
Nam ul mortgagee or contract seller
T 'aj-:J ' ' l o.1 1 Moue Home(tC 61.1-7)
� SkS� r L. !\c,� Ar.
Address of nxnlgeyee or contract seller(number and street,city
NneciCaq
Name of assignee or other owner or holder of mortgage ' 7o �_,Z�Q
l l \UU 000 .00
h
Address of assignee(number and street thy slate,and ZIP con
Does applicant can property in any If yes,what county? - What Taxing District? Has this dedicion been requested If yes,state amount of deduction
other county ❑Yes ❑No aarem�f0f Dyes 0 N
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 fine of audit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR ' - -Deduction approved in the amount of
I .
20 20 20 20 20 20 20
Signature of CowiyAuzGw County Date(mtmh,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.
. rj�d full name)
i j��s.aty/- tit_ /\�) ) Date(/ day,real 1
F ..? f C( 9m. �] — uP V't_. !�'•” "1 b Y /gyp
ti Pusan authorized by duly esearted Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,ply,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.