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Home My WebLink AboutMortgage_Genco �, STATEMENT OF MORTGAGE OR CONTRACT INDEBTED E j b,.unty Township Year : FOR DEDUCTION FROM ASSESSED VALUATION `! State Form 43709(R13/10-15) I �--- Presorted by Department of Local Government Finance INSTRUCTIONS: DEC 12 2017. File Mark To be filed in person or by mad- Form filed with: Fling Dates 1) Real Properly Must be completed and dated in the calendar year for which the deducto•is ..• L Must be filed or postmarked with the County Auddor or County Recorder of the•• •-��ItTI lv:propertryb•is 4NroCounty Auditor located on or before January 5 of the immediately succeeding calendar year Y &LINT On 2) Mobde/Manufactured Homes not assessed as Real Property:Must file •n:• : C¢i]myrwditor of the county County Recorder where the property is located during the twelve(12)months before Maw • each year the deduction is sought See reverse side for additional instructions . number Page number //Onc o�r� : a (D-/ a -o7- ' AO/ ,SY7oR . ? ArrG Assessed value of real piupeiry as of Mortgage I Contact indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole assessment date,current year date,cement yeea?ar date of appil Lion legal or equitable owneR �o3 if? U ❑ Yes ❑ No tf no,what is his/her exact share of interest? If owned with someone other than spouse,mdxate with whom If name on record is different than that of appficent,indicate below Is the property in question:Annually Assessed eat Property ❑ Annualy Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller Address of mortgagee or contract seller(num as ttr� sseet city,sate,and ZIP code) stt Name of assignee or other o era older of mortgage DrawerNO....( ,A1OI (•�•u••..• Address of assignee(number and street,city state,and ZIP code) 1 1 7t O U • Card NO. l if Does applicant own property in any If yes,what county? Whit Taxing District? r deduction other county r in Indiana? ❑Yes ❑No I u,1mM year, u yes- I_I N° • 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 recorders office(including any home equity line of credit that is recorded in the county recorders 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 I contract buyer c-1 >aforementioned property on date application is filed- Signaw _owners ` - -) Date(month,day,year) Full -••: t-•- ..a.-•'.- t(number aao�gqstreetaty,state,and ZIP e) f� 7 c 4Ja2a Y� 'y7to 76 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 ay,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. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year iell FOR DEDUCTION FROM ASSESSED VALUATION = State Form 43709(R13/10-15) Prescribed by Department of Local Government Finance ��', INSTRUCTIONS: le 1�ry H To be filed in person or by mail. Form filed with: Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. 4 Must be filed or postmarked with the County Auditor or County Recorder of the county where the property JAN 9 [�(AifilInty 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 count where the property is located during the twelve(12)months before March 31 of each year the deduction is s t. See reverse side for additional instructions and qualifications. -• �� Applicant(ownnee or contract buyer-see rest'lions on reverse side) GIBSON COUt�r6r v•-,r, _ • `Trego7 1 c,anre F-t. lf (lit 4 ��rJ(r-) Taxing District / / K y number/ egal descri Lion Record numb/K Pa a number 46 - /d- Q i- VD / —nr -SY7-o2T I'� 18 (o Assessed value of real property as of ortgage/Contract in ebtedness Unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole assessment date,current year/ I� assessment date,current year date of application p l I/ '7 y/� legal or equitable owner? (P if 3 bt ()M Y ! U - Yes ❑ No If no what is his/her exact share of interest? If awned with someone other wan spouse,indicate with whom If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed .p.4fre-al Property ❑ Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee tract sfeller �/�f /' / Urfg4 ( `tekyi fin jT P7c �i4�q r/(r Address of mortgagee r contract Der( tuber en see,city,state,and ZIP code) Name of assignee or other owner or holder of mortgage Address of assignee(number and street.city,state,and ZIP code) Does applicant own property in any If yes,vihat county? What Taxing District? Has this deduction been requested If yes,state amount of deduction other county , property for in Indiana? Yes 0 No current year? ❑Yes 0 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 I 20 20 20 20 I 20 Signature of County Auditor County Date(month,day.year) I 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 aforementioned property on date application is filed. Si tur (owner full nam Date(month,day,year) Fun resid nt dress of appli' t number dstr t.city,state,and ZIP code) // c 7 F_ (,c ,(--jer Si, Kt/ n cC - JDJ 7O Person authorized by duly executed Power of Attorney or by IC 6-1.1-12- 7 to onth,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 S10,000.