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HomeMy WebLinkAboutMortgage_Hurt (7) -. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS lR FOR DEDUCTION FROM ASSESSED VALUATION County Township Year 1t_ Slate Form 03709(R13/10-15) Prescribed by Department of Local Government Finance INSTRUCTIONS: File Mark To be filed in person or by mail. Filing Dates: 1) Real Property Must be completed and dated in the calendar Forth filed wdh. Must be filed or year Recorder which the county deduction is sough. postmarked with the County for 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) where he property is located Homed not assessed as Real nths bef Must file 31h foe ch year the da o I nit my Redxder wheadiinal instrisis and qualifications.the twelve(12)months before March 3101 each year the dad is ht. See reverse side for additional instructions arrd qualificetlons. Applicant(owner or contract baler•see restrictions Record number Page number (D(0 l c- MoD-coy SS- ©a-7 • Assessed value data,�lxroperty as d M /Contract Indebtedness unpaid as of Mortgage/Contract indebtedness�wr.1/p,rr�*i rn,Tf > assess date,current year date ofapp&aattiiion GIBSON COUNT gl wrier? Ono,what is h'¢Ihp exact chore of interest? l� r coo . On '@'Yes ❑ No If owned with someone other than spouse,Indicate with whom If name on record Is d'dferent than that of applicant,indicate bebr- Is the property in question:Annually Assessed [3 Real Property ❑ AnnuaM Assessed Name of mortgagee or contract seller (�/� �l ,, MobOa Noma(IC 61.1-7) Address mortgagee or �( ,s�n ��l i et t �,and ZIP codeLf C.) nd D r +P contract Name of assignee or other owner or holder of mortgage . Address of assignee(number and Stint ply state,and ZIP code) Does applicant own property in any if yes,what county? What Taxing District? other county rYO r19 Has operty for l been requested If yes,state amount of deduction in Indiana? ❑Yes U parent year? ❑Yes ❑No A person is not entitled to this deduction unless the person has a ba lance on the person's mortgage or contract indebtedness that is recorded in the county recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction. COUNTY AUDITOR Deduction approved on the amount of: 20 20 20 20 20 20 20 Signature of County Auditor County Date(month,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. S' nature(owners ha name) (cop^ •/day ye Date ((Wild WU AA 71// / 7 Full resident address of applicant(number street, /� r Person 3q S bjaeyr�v,�-, Ko�>P-K-i-�and frtnec-Fon,:-E1 LIR(C7c Pole` month,day,year) Address of authorized person (number and street,city,state.end ZIP code) The penalties for per)ury can include imprisonment up to Mu and a half years and a fine not to exceed$10,000. RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDN _ r