HomeMy WebLinkAboutMortgage_Shanks s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ' County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
'- State Form 43709(R13/10-15)
�-- Prescribed by Department of Local Government Finance
INSTRUCTIONS: _ File Mark
To be filed in person or by mail Fonn filed with:
Filing Oates.: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or pos marked with the County Auditor or County Recorder of the county where the property is 0 County Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property Must file with the County Auditor of the county County Recorder
where the properly is located during the hvelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(mvnerMrarl/Uer � Sde) D c1^ - n ia
Taxing District
&lb 1 3- 14- 9 00- LJCJ X• rp Foot, Record n e number
Assessed value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage!Contract indebtedness unpaid as of U the applicant the sole
assessment date,=mart year assessment date,current year date of legal or equitable owner?
CZO f ❑ Yes ❑ No
If no,what is his/her exact sham 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 property in question:Annually Assessed
• - ❑ ] AA i m C6-1.1-T)•Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street city,&al fl+r►e�e...e�,,r, 1 r DEC . 1,2017
. Drayt;cr Nt r a01 t7,
Name of assignee or other owner or holder of mortgage h •••_••••;•....,.
Card C /7� ^ Skit
Address of assignee(number and sheet,My,state,and ZIP code) 1'O, ,,,..�`� /� GIBSON COUNTY AUDITOR
applicant Does ova property in any If yes.what county? 43021i/00o.00 ...•••......� 1 If yes,state amount of deduction
other county in Indiana? ❑Yes ❑No I I current year! u Too o
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 correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Si re or name) Date(month,day,year)
F 1 resident address pecant(number anand cdy,state,and ZIP e)
P 5 Dby duly ex Power of Attorney by IC 1-12-0.7 �� �� Date(month,day,year) _ _ _
Address of authorized person (number and street dry,state,and ZIP code)
The penalties for perjury can include imprisonment up to!coo and a hat years and a fine not to exceed$10,000.