HomeMy WebLinkAboutMortgage_Hunt (4) }, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS hip Year
i't.-' FOR DEDUCTION FROM ASSESSED VALUATION
1'- State Form 43709(R13/10-15) --ti
Prescnbed by Department of Local Government Finance
DEC 12 204i?e Marts
INSTRUCTIONS:
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 sou
Must be filed or postmarked with the County Audrtor or County Recorder of the county where County Auditor
boated on or before January 5 of the immediately succeeding calendar year GIBSON COUNTY AUDIEbPFounty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
%hem the property is located dump the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Appbcant( or contract b7uyer-see rasa on rears?side)
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rAM?fft i i o6ao5� ay iag9 crag" Record 399,2
•
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mort gage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,cunem year assessment date,current year date of application legal or equitable owner?
/07 a g"/ ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of apphrant,indicate below Is the
property in question:Annually Assessed
r'I9 Real Property ❑ AnnualyAssessed
Montle Hone(IC 6-1.1-7)
Name of mortgagee or contract seller
I��,�
Address of or seller(number and street 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,what county? What Taxing District? —1(xn (1 k rv//��'1 lucliwt
other county `
in Indiana? ❑ �1 J
Yes ❑No \�r1��, ^_�
• A person is not entitled to this deduction unless the person has a balance on the per III�` 1 i_ he county
recorder's office(including any home equity line of credit that is recorded in the cow Ill 1
COUNTY AU ) "l RI �(� 9-21-'
Deduction approved in the amount of: �/
20 20_ 20 20 20 20 I 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/aff000rreem/enntioneedd property on date application is filed.
Sig !/ V • ' " , - / _ Data(month,day,year)
Full address of applicant(number and street cilY.slstate,V ZIP code)
a.zo.5 �� 0y-2_� ��r�� � �f•71 70
Person authorized by duly ed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,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.