HomeMy WebLinkAboutMortgage_Friedner STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
:t oate Form 43709(R13/10-15)
Prescribed by Department of Local Government Finance
PISTRUCTIONS:
1'4 a1 I
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b be filed in person or by mad. :
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought. n
Must be filed or pos marked with the CountyAuditor or County Recorder of the county where the properly is Ain, �1 c"a[o1!Audi
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 county County Recorder
where the property is located during the twelve(12)months before March 31 of each year the deduction is .. ., . mew—
See
See reverse side for additional instructions and qualifications. . . :I�t r
AppUrant(owner or restrictions on GIBSON•COUN IV AUDI I UK
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Tastg Disbia lnh�t .�1 - yo►t-moo•qbi -oa8 moo'7 `3
Assessed value of real properly as of Mortgage/Contract indebtedness unpaid as of - Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,anent year assessment date,arrant year date of apppr(moo`}^ /y legal or equtaMe owner?
76 �Jp( • W ❑ yes 0 N
If no,what is his/her exact share of interest? If owned with someone other than spouse,indi cate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
❑ Real Property ❑ Mobile Annually Assessed OttuietaiD Mobile Home(IC 6-1.1-7)
Nacre d mortgagee or contract seller UU
Address of mortgagee or contrail seer(number sfr€eI,city, .and ZIP code) '
.
Name of assignee or other owner or holder of mortgage '
Address of assignee(matter end street wry,ate,and ZIP code) F 7p/'�}/' p
Does applicant own pupoty in any t yes,what calory? . What Taxing District? Has this t - r �^-'`n l.-I I ' ^ - —
iIndia ? CI Yee ❑No anent �uItU
A person is not entitled to this deduction unless the person has a balance on the person's mortgi /'2-3�//'`3 l r
recorder's office(rndudmg any home equity line of credit that is recorded in the county recorder' 7 V
COUNTY AUDITOR " _
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County At dtw County Date(month,day,year) '
I I We certify under the penalty of perjury that the above and foregoing information is true and cored and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
S fs tut name Date(month,day,year)
Fug mI0 (nu a and street city, ate and LP code) c /� t' '2 (7
Person authorized by duly executed Power of Attorney or by IC 6-1.1-120.7 `�}W7~_, _��(/�_vL [l Date(month,day,year)
Address of authorized person (number and sheet 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 510.000.
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