HomeMy WebLinkAboutMortgage_Bacon (2) , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS county Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
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State Form 43709(873/1415)
Presaibed by Department of Local Government Finance TT g
INSTRUCTIONS:
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To be filed in person or by mad.
Fling Dates:.1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is rlty udd
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located on or before January 5 of the immediately succeeding calendar year. JUN
2) Mobile/Manufactured Homes not assessed as Real Properly.Must file with the County Auditor of the county my Recorder
where the property is bested during the twelve(12)months before Mardi 31 of each year the deduction is
See reverse side for additional instructions and qualifications. .f ILp,,, q
0e O1Op"L b"/efw )n 4 GIBSONN"COUNTY YtAUDITOR
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Taxing District t -09-a4-30a-ono.(�(�� ifittek 20 Record�` ( `• P ` ( r'�
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of - Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment dais,current year • d year date of application legal or equitable owner?
® tl c3prent 1 ❑ yes ❑ No
If no,what is his/her exact share of interest? �!O If owned with someone other than cprxrcP,indicate with whom
If name on record is afferent than that of applicant,indicate below. is the property In question:Annuuaayey Assessed
• El Real Property ❑ Al ua Horne Assessed 1.1'7)
Nacre of mortgages or contract sew �J(�1\1►/-'�1}
Address of mortgagee or contract seder(number and street city,Sdte,and ZIP code)
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Name of assignee assignee or other owner or holder of mortgage '
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Address of assignee(number and street rdy,slate,and ZIP code) •
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Does applicant own properly in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
rind'county? ❑Yes 0 N current year? Yes ID 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 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 County Aueor 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 I contrail buyer of the afo < -, •• • • •perty on date application is fled.
S" (• / - 11 . e) / Date(month,day,year)
/ / 0- 3o-fel
Fug —_./address ofapp6"0 (n ' •4 and street,city --i ZIP...e)
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authorized by duly executed •• -- of Attorney or by IC 61.1-12-0.7 Date(month,day,}ear)
Address of authorized parson (number and street city.state,and ZIP code)
The penalties for perjury can include imprisonment up to hvo and a half years and a fine not to exceed 510,000.