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HomeMy WebLinkAboutMortgage_Askren (2) • ,w STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year avFOR DEDUCTION FROM ASSESSED VALUATION State Form 43709(R13170.15) - - 'g' Prescnbed by Department of Local Government Finance F I N INSTRUCTIONS: �H�dl To be fled in person or by mall. - Form filed with: Filing Dates: 1) Rea!Property.Must be completed and dated in the calendar year for which the deduction is sought. JUN 2 3 u 1 Must be filed or posbnarlced with the County Auditor or County Recorder of the county when the property is County Auditor located on or before January 5 of the immediately succeeding calendar year. 2) Mobile/Manufachaed Homes not assessed as Real Property.Must file with the County Auditor of the ativt Recorder where the property is located during the twelve(12)months before Mardi 31 of each year the deduction See reverse side for additonalinstructions qualifications. GIBSON COUNTY AUDITOR ' Appfaant(emperor n re .a- Taxemg District • �iyCit esornc/ 'O LKif/-oco.pa gr a g, L Pl � U r Assessed value as of idebtedness unpaid as of • Mortgage ude unpaid as of � ant the so sole assessment current o1 , V` date of legal equ ❑ Yes ❑ No • If no,what is his I her exact share of interest? If owned with someone other than• nt re,inchoate with whom If name on record is afferent than that of appfrant,indicate belay. Is the property In question:Annually Assessed ❑ Real Property ID Mobde Anna-Ay Aessed Home(IC 6-1.1- I Nacre of mortgagee or mmtrari miler ( n MA „ . 1 1 (;'I Address of mortgagee a aWrart seller(ruanberand street city state,and ZIP code) Name of assignee or other owner or holder of mortgage ' . Address of assignee(number and street,oA:state,and ZIP code) - Does applicant own pn.y,enty in any If yes,what county? • What Taxing District? Has this deduction been requested If yes,state amount of deduction other county in India a? ❑Yes 0 N currentyea?fix ❑Yes 0 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 egwiy fine 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 cif: 20 20 20 20 20 20 20 Signature of CaadyAudltar 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!contract buyer of the aforementioned property on date application is filed. Data(monN,day,Year) okg - P3- Don cresident address of (number and street,oitY.state,and�pZIP code) /518 /_ a(Laeyor► ©d �I 1f-16e-0 . Person authorized by duty executed Power of Attorney or by IC 61.1-1 a 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$10,000.