Loading...
HomeMy WebLinkAboutMortgage_Golden �: STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year Ems" g�' FOR DEDUCTION FROM ASSESSED VALUATION �$y'; State Fortn 43709(R131 10-15) '-- Prescribed by Department of Local Government Finance ��X(( 1� INSTRUCTIONS: F''Fit- Mala•J To be filed in person or by mail. u -. KKKKfiIed��' . Filing Dates 1) Real Properly Must be completed and dated in the calendar year for which the deduction is sought fff777 Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is JAN Canty 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 county where the property is located during the twelve(12)months before March 31 of each year the deduction is so •- See reverse side for additional instructions and qualifications. . :1i. --ii ,.OP; Applicant(owner '•'CV Oms°n 'sae)h GIBSON COUNTY AUDITOR c-,78- M[ O Q/Y\ Taxing District Record nu r Pall umber -I - fwd-303 - CDO -(oL 9 -ay) g 3 Assessed vahre of real property as of Mortgage Contract indebtedness unpaid as of Mortgage r Contract indebtedness unpaid as of Is the applicant the sole - assessment date,anent year assessment date,current year date of apn legal or equitable vier? If no,what is his/her exact share of interest? If owned with someone other( i ❑ Yes ❑ No spouse.indicate with whom N nacre on record is different than that of app5a— ------` _ __- __ is the property in Question:Annually Assessed /� ❑ Real Property ❑ t age 6-1.I-7) . Name of mortgagee or contrail seller r /O1 �/ Drawer NO o`/ 6 Address of mortgagee or contract seller(numb[ Nacre of assignee or other owner or holder of Card NO. 9.3 Address of assignee(number and street d4' state,and ZIP code) Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction other in iaanna?h ❑yes ❑No on property ❑Yes- 0 No • A person is not entitled to this deduction unless the person has a ba lance 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 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/co ct buyer of the aforementioned property on date application is filet Signatu try.name �J Date(mouth day,ye I'o2 S-1 Full addreapplcant l ( mebernd�reetcity,st ate an 2P code) auO � Ur ©ca^U i� O Person authorized by duiexecuted Power mey cur by �C 6-1.1"12'O 7 Data(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 haff years and a fine not to exceed$10,000.