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HomeMy WebLinkAboutMortgage_Campbell >< STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year "r. FOR DEDUCTION FROM ASSESSED VALUATION - State form 43709(R}31 70.1 �' Prescribed by Department of Local Government Finance INSTRUCTIONS: F e y3 TO be filed in person or by mail. �T 1 �... -�with: Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is ht Must be filed or posbnarIced with the County Auditor or County Recorder of the county where the property is s Z 1: County Auditor located on or before January 5 of the immediately succeeding calendar year. 00 I ❑ Courtly 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 Mardi 31 of each year the deduction is sought See reverse side for additional instructions and qualifications. /1b, Applicant or aJa t': � �7n. . J��,,, ) GIBBON COUNfY AUDITOR Taring Districtv(1'"��v Ke / — © _ Record number Page number ` (7-j till DI I Dad a0s7 y�aa Assessed value of real property as of Mortgage/ indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole assessment date,current year assessment date,aurentymr date of application legal or equitable owner? (/L° ^�..a(Y./5 ❑ Yes ❑ No If no.what is his/her exact share of interest? If owned with someone other than sprvicr,indicate with whom If name on record is different than that of applicant,indicate below: Is the ptup ety in question:Annually Assessed nyilltal Property ❑ AnnuallyAssessed • Mobile Home(IC 6-1.1-7) Name of orcontract Iler `//7 Adtl�1 or contract seller 211mber and t :state.and ZIP code) 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 any If yes,what county? t\1rat Taxing District? Has this deduction been requested If yes,state amount of deduction other county on in property n ❑iana? ❑Yes ❑No current 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 f ntract buyer of the aforementioned property on date application is filed. Signature(bon �Dname l l Date(month,day,year) Full resident a address of aappeant(nu a and street . ,slate,and ZIP code) g O 9 3L/ctec ce ' ill!(/e F+on—i3G4ic 4-, fit, ci-i(o 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 sheet city,state,and ZIP code) lal for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. __ - ..