HomeMy WebLinkAboutMortgage_Smith (45) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
\
t j FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15)
`- Prescribed by Department of Local Government Finance '- D
INSTRUCTIONS:
File
To be filed in person or by mail.
Filing Oaten 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 pro pert4fJ nnn 2 2 �i County Auditor
located on or before January 5 of the immediately succeeding calendar year. /County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property Must file with the County Auditor of the county
where the properly is located during the twelve(12)months before March 31 of each year the deduction is t
See reverse side for additional instructions and qualifications.
Applicant(R buyer-see ms 'ca'onsonreveae side) GIBSON CO„` NUNN---TY���AUDITOR
T D. d Key number/legal description
ae21 - /2 - 300 - 002. 3) x -0?-Y ?&Rerxxd ) Tb4
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value of real property as of Mortgage!Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the sole
assessment date,current year assessment date,rent year date of application legal or equitable owner?
S
Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spofise rotate with whom
If name on record is different than that of applicant,indicate below: I�s,th/e property in question:Annually Assessed
I1TReal Property ❑ Annually Assessed
7T' Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller /)
S //.hl
Address of mortgagee or contract seller(number and street, ,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee city,state,and ZIP code) ..
Does applicant awn property i—' -- 1 ;s this deduction been requested If yes,state amount of deduction
other ❑Yes C , 7Ot\S� Sry-ilC . jtJ Tent year? ❑Yes- 0 N
A person is not entitled to b if ��l ortgage or contract indebtedness that is recorded in the county -
recorders office(including. k t c„ e c.x-
t{p a,, 5�G_ dens office)that is the basis for the deduction.
Deduction approved in the am `S O 0 . 0 O $ - 'n
k 1-�} 1
20 °'� 11 — `o�I 20 20 20
I I I
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 correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforemention(((eeeddd��,property on date application is filed.
XSig '• -%rim /
F e`` � I Date(month,day,year)
address of applicant(number and streett city.state,and P )
1345 UJ . u) IeQ#(arC yavloS5adIt T v 47 9
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
/dress 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.