HomeMy WebLinkAboutMortgage_Mills (5) „, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
}� FOR DEDUCTION FROM ASSESSED VALUATION
` = State Form 43709(R13/10-15)
Presaled by Department of Local Government Finance
INSTRUCTIONS: _ Trap
To be filed in person or by mall. g®
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
located on or before January 5 of the immediately succeeding calendar year. NOV[a] CdurtniiRecorder
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 deduction is sought
See reverse side it additional instructions and qualifications. ,(ii
Appfxant(owner..w. .. buyer-see restrictions on 0$-si /� • /1 n N°w
a „ I 1 lhJ(r/1�1�� GIBSON COUNTY AUDITOR•
Taxing District nu . t -fl'1- l D3 -CO3 —06?-0 ? R j"f 3%'Lb
number
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the a sale
assessment date,current year assessment date,anent year date of-ion ll legal or equitable owner?
I �0 SD ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than rpm Me,indicate with whom
If name on recent is different than that of applicant,indicate below. Is the property in question:Annually Assessed
0 Real Property ❑ AnnuallyAssessed
Mobile Hone(IC 6-1.1-7)
Name of mortgagee or contract seller -t-1 O _ - ,
Address of mortgagee or contact seller(number and street city,state,and ZIP code)/'w aJQ - :�1.•
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sheet,city,state,and ZIP code)
•
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on
in Indiana? ❑Yes ❑No current year??for ❑Yes Ill 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,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 filed.
Miners(owners f i7 Date(month,day,rear)
(INVII �WU' 1 g
116\v\NOWiJ state,and 91v1%
n authorized by duly executed Power of Attorney or b y IC 5-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet dry,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.