HomeMy WebLinkAboutMortgage_Trader STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
'('% State Form 43709(R13/10-15) •
C-. Prescribed by Department of Local Government Finance
INSTRUCTIONS: • Fi
To be filed in person or by mail. -
Filing Dates I) Real Properly Must be completed and dated in the calendar year for which the deduction is sought '''fff���111
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ji hR 2oe!tuditor
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 county
here the property is located during the twehm(12)months before March 31 of each year the deduction is soughtJ��^.
See reverse side for additional instructions and qualifications.
Applicant orconbaagann-seeginmsogmyers�side) ^ GIBSON COUNTY AUDITOR
T-•^ i LC•�,cY}— :numbrU_I'}V1 cdescd - r^1~Gyn•(/ 'p ,v Record number Page number
L ! 3(9 - i1-/ r4o3 -OD E < n-oo') 40i2 ..I/ 2
+->-_•value of -- )•.- as of Mortgage!Contract indebtedness unpaid as of Mortgage!Contract indebtedness unpaid as of Is the applicant the sole
assessment date,•• :yam., assessment date,current year date of application legal or equitable owner?
I cs 8a9 01 Yes 0 N
If no,what is his I her,i i.- ,. :of interest? If owned with someone other than spouse,indicate with whom
If name on record is Meted than that of appliicant,indite below. Is the property in question:Annually Assessed
II Real Property ❑ AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller Mt;if r /,
Address of mortgagee or contract setter(number and street city,st*4 and ZIP code) /1_ _J�
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street dry,state,and ZIP code)
Does applicant ap own property in any If yes,what county? rat Taxing District? Hsi this deduction been requested If yes,state amount of deduction
for
in Indiana? ❑Yes ❑No _ • - =rent ear? ❑Yes- ❑No
• A person is not entitled.--
ntitled is mortgage or contract indebtedness that is retorted in the county
recorder's office(utdud . O t -3 1 Th recorder's office)that is the basis for the deduction.
I c y`1y `) > 3R
Deduction approved in the Je..>n E. ok SCO \` `Y�'`c
20 5 S I Y aT• 0 C> 20 20 20
Signature of County Audito \-)A..l? Data(month,day,year) - -
• 1
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!contract buyer of the aforementioned property on date application is filed.
Signature(owner1's fun name) XIm Data(month,day,year)
,, - /h 'I Scr v,C�1i I YGtQgci •
Full resident address of appl dht(number and street dry,state,a ZIP code)
1 Person authorized by a31-1 duty S la( k s-1- . 2-0D ct K 1 and e i�l-y , I-11 P LP d(month,dayY�)
Address of authorized person (number and street city,state.and ZIP code)
The penalties for per)ury can include imprisonment up to two and a half years and a fine not to exceed S10,000.