HomeMy WebLinkAboutMortgage_Price (5) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
w - State Film 43709(R13/10-15) .
�`f�'� Prescribed by Department of Local Government Finance
F LE
INSTRUCTIONS:
To be filed in person or by mail. Fond filed with:
F7ng Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought JUL 2 ��7
Must be filed or posbnarked with the County Auditor or County Recorder of the county where the property is tea Auditor :
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property.Must file with the County Auditor of the ceun 0 rn Recorder
where the property is boated during the twelve(12)months before Mardi 31 of each year the deduction is
See reverse e• a for additional instructions and qualifications.
Appficant(o m`-� GIBBON COUNTY AItf11T(1R
buyer- sonre eside)
Taxing District Inumber
�1 i1-coq aoa-oo� . go- 6;49 Record n0 number Page s
Assess vale of real{roper as of ((!//��� Mortgage/Contract indebtedness unpaid as of • Mortgage I Contract indebtedness unpaid as of Is the app ant The sole
assessment dam,current year assess date,ourent year date of application legal or equitable omen
• I 300 ❑ Yes ii No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below. Is the property in question:Annually Assessed
• ❑ Real Property ❑ AnnuallyAssessed
Mobt1e Nome(IC 61.1-7)
Name of mortgagee or contract seller
g-sti u
Addmss 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 say,state,and ZIP code) .
-
Does applcant own property in any O yes,what on been requested If yes,state amount of deduction
other county in Indiana? ❑Yes ❑Nil a01.11 ]Yes ❑No
A person is not entitled to this deduction un less Drawer N O , nbact indebtedness that is recorded in the county
recorder's office(inducting any home equity fine (`�� tat is the basis for the deduction.
Deduction approved in the anountot Card �NO. ,�j)C�J���9 I `s .
-
20 20 s,. l �' 3l cam [u 20 - 20
Signature of County Auditor County Date(moron,day,year)
I/We.-t. - • : the pe ci pe• the a.• oing'udormabon is true and correct and that the applicant is a resident of Indiana and
owner/flair., . -r of I/AU aforem prope i•n-:application is filed.
'f. ,. - (crlram/ l 11 a ' 7
F a - _- address of number and sheet c77yrcta- and ZIP code)
Person authorized by duty exewted Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street oiy,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. ..