HomeMy WebLinkAboutMortgage_Monroe (2) a 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 AR�n
INSTRUd in pea: F T e m ;
To be filed in person or by mail. g9I
Filing Dates: 1) Real Property Must be completed and dated in the calendar year fat which the deduction is sought '� • ��
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is m❑ County Auditor
located on or before January 5 of the immediately'succeeding calendar year Q �f-�(kwrtry Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the county
where the property is located during the hvehe(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyerr see on reverse Vold,
'i(1 //���� Ct old, q �y� �y GIBBON 7COUNTY AUDITOR
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Taxing District ao a-01- 3V 3 - OD • 1.10108 Record Iur5 le" "
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage l Co indebtedness unpaid as of •Is the applicant the sole
•
assessment date,current year assessment date,amen year ddaalteg�BQ(ffi� 3 legal or equitable owner?
If rc,what is his 1 her exact share of interest? If owned with someone other than s ❑ Yes ❑ No
spouse,indicate with when
If name on record is different than that of applicant indicate below Is the
property in question:Annually Assessed
❑ Real Property ❑ AnnualyAssessed
• Mobne Home(IC 61.1-7)
Name of mortgagee or contra=seller R
Address of mortgagee or contract 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,stab a� — k Da-
Does
Doer apple applicant own property in any If yes,what \ " � C y- ��.v 4 ( �(3- en requested If yes,state amount of deduction Ce
in Indiana? ❑Yes ❑No B 1 es. ❑No
• A person is not entitled to this deduction utile p 3�.j, 0 v act indebtedness that is recorded in the county
recorders office(including any home equity I 1 is the basis for the deduction.
k7
Deduction 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 penury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature( Date(month,daY.Yea)aci //p '" i
Full ot applicant�lumberystreet city,state,and ZIP code)
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 sheet dry,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.