HomeMy WebLinkAboutMortgage_Smith (18) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
' rid
FOR DEDUCTION FROM ASSESSED VALUATION
Slate Form 437 (813/10.15) .
Prescribed by Department of Local Government Finance
INSTRUCTIONS: g t
To be filed in person or by mail. e tied with:
FTug Dates: 1) Real Properly:Must be completed and dated in the calendar year for which the deduction isligtdl
Must be filed orposfrnadced with the County Auditor or County Recorder of the county where the properly is. ❑ County Auditor ,
located on or before January 5 of the immediately succeeding calendar year. I��K�I�
2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the r'ncmty Auditor ot}hd%o6gg
tfj 20 1 I ❑ County Recorder
where the property is located dump the twelve(12)months before Mardi 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(oimer ea resefcfims on Ire`IE� .
VV ^'/? �jCaGl�d'�[f`;yy30a- ow .('�'JQ��� GIBSON COUNTY AUDITOPRag)eLn�w[��g
Taxing District - ` D V i 'mil L—► ' ow—cos- Record r. OC J —I`'1
Assesedvalue draal property as of Mortgage/Contract indebtedness unpaid as of • Mortgage I Corte indebtedness unpaid of Is the applicant the sale
assessment date,and year assessment date year— \ data of application legal or equitable owner?
/"T) 3tlCy./) ❑ Yes ❑ No
0 ro,what is his I her exact share d interest? If owned with someone other than spouse,indicate with whom
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if name an resod is different than that of appirarn,indicate below: Is the Property N question:Annually Assessed
❑ Real Property ❑ Amwaliy Assessed
Mobile Home(1C 6-1.1-7)
Barre d mortgagee or contract seller ,n10 .
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage '
Address of assignee(number and street ay,state,and ZIP code) -
Does applicant own properly in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county property Indiana? ❑Yes ❑No - anrenyear? ❑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 egw'y 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 of
20 20 20 20 20 20 20
Signature of CmmtyArrdsor Dainty Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
., .,. (. e. •r name) Data(month,day,year)
W :,-..ant address of applicant(n and sheet city,state. ZIP aide)
V 209 5 3" sfect X76 gm
Pest aut orized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
AdRedress of au hor®tl person (number and street ate.state,and ZIP code)
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The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.