Mortgage_Garwood t ;r; STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
Cjet•I.:f- FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R131 10-15)
Prescnbed by Department of Local Government Finance
INSTRUCTIONS: • j j
To be filed in person or by mail. I F ,:
Filing Dates 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought'
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑ County Auditor
boated on or before January 5 of the immediately succeeding calendar year. S
Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the properly is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or contract�buyer see�restrw((U�ons��oy�reverse side) I ,� Dc-o--,41/4. GIBBON COUNTY AUDITOR
Taxing D"l a 1t fl GV rt>C-�-( SA 4i __ Record number Page number
4C, -o (0-b"l - hbO - oo. _ a6,c, - ali ao, 7 `'/O70
Ash value of real p as of Mortgage 1 Contract indebtedness unpaid as of Mortgage I Contract ind ness unpaid as of Is the applicant the sole
assessment data,wrrent any nt artrent year date of application legal or equitable Amer?
t a 4 1 11 Yes ❑ No
It no,what is his/her exact share of interest? J If owned with someone other than spouse,indite with whom
If name on record is afferent than that of applicant,indicate below: i�Q
s the p,Iroperty in question:Annually Assessed
`� . Property ❑ MnuafyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contact seller(number and sbeet city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street dry,state,and ZIP code)
Does applicant own properly in any If yes,what county? What Taxing District? I If yes,state amount ci deduction
other county in Indiana? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the perso Dr,tinter. 7e court
recorder's office(induding any home equity line of credit that is recorded in the count) 1 '•n county
COUNTY AUD'
Deduction approved n the amount of Car-d No .L/0 ^J�
lJ ,jo
20 20 20 20 c
„ 20
I_
Signature of County Auditor County l Date ti,.-.
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 flied.
Signature(• ' ‘. 1;name Dale(month,day,year)
V) , ! /Z 7(Zmt7
Full ;.. _..,a- of a.., « t(n and street city.state,and ZIP code)
LQ " 9 F 6 -/4c. if'v��.� /Yz`fv
P- -r authorized by duty executed Power of Attorney or by IC 6-1.1-12-07 Date(month,day,year)
Address of authorized person (number and street city,state,and EP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.