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HomeMy WebLinkAboutMortgage_Market (4) SSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year FOR DEDUCTION FROM ASSESSED VALUATION Stare Fonn 43709(R13/10-15) Prescribed by Department of Local Government Finance fie rip Filing D tes:INSTRUCTIONS: p sought F I 1J To be filed in person or by mail LLII Filing Dates 1) Real Property.Must be completed and dated in the calendar year for which the deduction is Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is County Auditor located on or before January 5 of the immediately succeeding calendar year. 1gQ�unly Recorder 2) Mobde I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the couNOV where the property is lasted during the twelve(12)months before March 31 of each year the deduction is sought See reverse side for additional instructions and qualfcations. Appfvant( or contract buyer-seelz an R ii JK,(. ITI metAi a GIBBON COUNTY AUDITOR Taxing D' a�i I destitution OO -O©O •043 doh') a0 7 number 03 Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole assessment date,current year assesvnel�date.current year date of application - legal or equitable owner? L-OOE VS0.00 ❑ Yes ❑ No If no,what is his/her exact share of interest? If owned with someone other than spouse,indicatewith whom • tf name on record S dherent than that of applicant indicath betoar. Is the property in question:Annually Assessed c (l _1- �{ o p Real Property ❑ Annu.alH 6-1.1-7) Nacre of mortgagee a contract seller C.._ l•• Address of mortgagee or contract seller(number and street city,state,and ZIP code) — - aon _<kco3 Name of assignee or other owner or holder of mort gage D ` er` W cnt-ko-Ni:te Address of assignee(number and street city,state,and ZIP code) \ • (\-\ e C k _ � C FC Does applicant own property in any If yes,what county? .What Taxing District? d deduction other county in Indiana? ❑Yes ❑NO I cuneri. A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is ro,,,.,,..J in the county recorders office(induding 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,year) I/We certify under the penalty of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and owner I contract buyer of the aforementioned property on date application is films. re( Date(month,day,yeas) •„,moo o(dS�num and ZIP rode) Roo • -r•L4 ��?U 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.