HomeMy WebLinkAboutMortgage_Kixmiller STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
ea cFOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13110.15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: f
t
To be filed in person or by mail J u� � .
Filing Dates 1) Real Properly.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 proPf fs ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. U 1. I 2 0 OM County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deductionAs sought
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See reverse side for additional instructions and qualifications. _/// t
n °NTeiorton8a� --"""or' GIBSON COUNTY AUD!TOR
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T�y Dstrict Key _ /legal tlescripfim Record number Page number
Y/��"� 0'�y" a - IA -o 7 -- /a/-00 d, . Lien -oxg 0Z0 /7 3.839
Assessed value of real property as of Mortgage 1 Contract indebtedness urryaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sale
assessment date,aumnt year assessment date,current year
data of application/ legal or equitable owner?
14 00 p ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other Man spouse,trudcate with whom
If name an record is different than that of applicant indicate below ______l nrooerty in question Annually Assessed
Name of mortgagee or contract seller ten,(
Drawer No Address of mortgagee or contract seller(number and street,city,state,and ZIP code) ..............
Name of assignee or other owner or holder of mortgage Ca 11,1 N O. .. 3 S 35
—
Addaof assignee(number en d�}xarte,/LP code) _
Does applicant ttt /ownn property in any If yes,what county? T What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes ❑No current year ❑Yes. ❑No
A person is not entitled to this deduction unless the person has a balance 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 in the amount of
20 20 20 20 20 20_ 20
Signature of County Auditor County - Date(month,day,yea)
•
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.
t. Signature(owner's fu(ll/l e) Date(mach,day,year)
I ent ad applican/ t(number and street city state.and ZIP code)
Vii k-). -Pr14cc_ Cfvw-c1- 1 rfi`r-ca.fw /N (/7Q7C
Person authorized by duly 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.