HomeMy WebLinkAboutMortgage_Hirsch (6) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
n�'{">-- FOR DEDUCTION FROM ASSESSED VALUATION
= State Form 43709 F I
— Prescribed by Departrnenl of Local Government Finance
INSTRUCTIONS:
To be filed in person or by mad. • t ,�7tq
Friug Dates.- 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. JUL! L U I/
Must be flied or posbnarked with the CountyAuddor or County Recorder of the county where the property is County Auditor ,
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Reel ❑ Cu eorder
Property. Must t with the each year the don of the county, 4 .
where the property is located during the twelve(12)months before March 31 of each year the deduction is ssoonugg )P,41
See revee side for addiitionalinstructions and qualifications.
GIBS 0N COUNTY AUDITOR
Apparent(owner or buyer- - on de'ak i6Wp .,4„,,
7 -J� -ao 4- CO l 340 - � Record 1 Page 3
Assessed value of real properly as of /Contract'indebtedness unpaid as of • Mortgage/Contract indebtedness unpaid as Is the applicant the sole
assessment dots,and year assessment date, year date of app5raan ti legal or equitable owner?
date, E1 Yes 0 N
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
tl name on record is dfferent than that of appfsant,indicate below. Is the progeny N question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Nacre of mortgagee or contract seller A - • -
Address of mortgagee or contract seller(number and 25/ 7
Drawer NO
Name of assignee or other owner or holder of mortga ^off
Address of assignee(number and sreet,r>ty.state,z Card NO. '25i ) . -
•Does applicant own property N any If yes,what a _ -
�•/- n been requested If yes,state amount of deduction
other county ❑Yes ❑No - I I a on ProgertY for? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mostyaye or contact indebtedness that is recorded in the county
recorder's office(ncluding 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 CountyAodla County 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
comer/contract buyer of the aforementioned property on date application is filed.
towns*tuft name) Dab(mmt,day,year)
y lavvK/] /
. _ say"` � ` : P°° a4 % LIP
Person authorized by duly executed Power of Attorney or by IC 5-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street ay,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.