HomeMy WebLinkAboutMortgage_Loveless (4) s; STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Fonn 43709(R131 10-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: _ Fil-Fist,
To be filed in person or by mail. , I'• ii
Filing Dates: 1) Real Properly.Must be completed th
and dated in e calendar year for which the deduction is sough —J .
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is �41 County Auditor
located on or before January 5 of the immediately succeeding calendar year. f(1 r 2 ti✓I ounty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the cthtnt>
where the property 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( oorraau -.see resaj�aras on rayce) .
vCJ fvo)!�__� GIBSON COUNTY AUDITOR
Taxing D�' t Key number/legal description Record n number
Ulun6 nit !o-/:? -07 -, ) 3 &, /..O/o4 oa � . . , f 0 V. .3.4.0%.
6
Assessed value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,anent year date of application legal or equitable owneP
1/4-53006 ❑ yes ❑ No
If no.what is his/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 properly in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
• Naga Home(IC 6-1.1-7)
Name of mortgagee or contract
CCU t er
Li •
Address of mortgagee or contact seller(number and sheet city state,and ZIP code)
Name of assignee or otter owner or holder of mortgage - �
Address of assignee(number and street dry,state,and ZIP a j /t -
"
Does applicant own property in any If yes,what county? flf`••�l�n(/�f0�4 quested If yes,state amount of deduction
other county
in Indiana? ❑Yes ❑No ❑No
A person is not entitled to this deduction unless the pet 2 p l R f r l C idebtedness that is recorded in the county
recorder's office(including any home equity line of aec /U l �-IF J 3 re basis for the deduction.
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Auditor County - Date(month,day,year)
I 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 - • -.• ntioned property on date application is filed.
S"r -.4 re(• --p '➢•ante / y Date(month,day.yea)
yr ul a.• of.:..�- (number and street city,state,and ZIP code)
P- authorized by duty 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 firm and a half years and a fine not to exceed$10,000.