HomeMy WebLinkAboutMortgage_Brackett (2) it..0 np . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
1_ FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R12/6-14) T. F .'— 't
/+ Prescribed by Department of Local Government Finance 9 i
9g 4
INSTRUCTIONS:
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. I II
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properl3II 7lL 1 9 NIL unty Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ Coun .Recorder
2) Mobile/Manufactured Homes not assessed as Real Property Must file with the County Auditor of the cggrltyy�
where the property is located during the twelve(12)months before March 31 of each year the deduction t'
See reverse side for additional instructions and qualifications.
Applicant(owner a'contract buyer-see restrictions on reverse side) GIBSON COUNTY AUDITOR
Donald R. Brackett
Taxing District Key number/legal description Record number Page number
Ft. Branch 26-19-19-204-001.312-026 J(� 3064
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1.current year date of application legal or equitable owner?
145,,.' .. nn p Yes ID No
If no,what is his I her exact share of interest? If owned with some - whom
If name on record is different than that of applicant.indicate below:
NI 443
Name of mortgagee or contract seller 3'�A �`(,.
��
Heritage Federal Credit Union
Address of mortgagee or contract seller(number and street,city,state,end ZIP code) /5388 Old State Hwy 66, Newburgh, IN 47630 - iQU c J
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in ny If yes,what county? What Taxing District? I
other county
in Indiana? ❑Yes al No
A person is not entitled to this deduction unless the person has a balance on the person' I
. recorder's office(including any home equity line of a-edit that is recorded in the county n
COUNTY AUDIT
Deduction approved in the amount of:
20 20 20 20 20 20 —
Signature of County Auditor County 1 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 I contract buyer of the aforementioned property on date application is filed.
Signature(owners ame) ��J Date(month,day,year)
u0 resident address of a (number and street,city,state,and ZIP code)
429 E 790 S, Ft Branch, IN 47648
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 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.