HomeMy WebLinkAboutMortgage_Arnett (3) ..}. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
"1."=f= FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13110-15)
S )-Li 1 Presrnbed by Department of Local Government Finance
INSTRUCTIONS: - ark
To be filed in person or by mail. e ,�1
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 ❑ Co'uflntyy Auditor
located on or before January 5 of the I runediate/y succeeding calendar year. DE On b.aun}y Recorder
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 for additional instructions and quaf:cations.
Applicant(owner or contract buyer-see re on reverse side) '
�
n
`-t- 7_ _st✓ C6 C Q — 0. GIBSON COUNTY AUDITOR
Taxing District number/legit?d °�'r ° 1\ Record number Page number
_, a.6 - 18 - 13 - gof -ooa, ri A-1 -oa.te aq0/7 .975-7
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,cunerd year assessment date,current year R
/ date of application legal or equitatbe owne
I t 1 o -2to ❑ Yes 0 N
G no,what is his/her exact share of Monest? 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
teal Property ❑ AnnualyAssessed
twbblie Home(IC 6-1.1-7)
�Name of mortgagee or contact seller o `' }(�I
of mMgageeT seller(nu ber andsbeet dry,suite,a YJP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city state,and ZIP code) _ Si
o�applicant own property in any If yes,what county? t \� —5 'S If yes,state amount of deduction
in Indiana? ❑Yes ID No � '00
• A person is not entitled to this deduction unless the person has -•-A �— - 4 Qa'_,, 'ss that is recorded in the county
recorder's office(including any home equity line of credit that is r the deduction.
N.( . Qr.r, a_ K C'1
Deduction approved in the amount of- M
VI 3 acct .ol
20 20 20 I cv I 20 20
Signature of County Auditor County - Date(month,day,yea)
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• -r of the aforementioned property on date application is filed.
Signature(• /: + • e Date(month,day,yea)
�F/u�ll reside ,C-d -is. of-pp r ( ; and city,state,and ZIP COde)
`-C i l IF- let en_.c Af. /3n---fwcer /,.,--- qpe —
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date Omagh.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.
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