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Home My WebLink AboutMortgage_Carpenter ,,4pe-� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year r `'; FOR DEDUCTION FROM ASSESSED VALUATION �'% State Form 43709(R13/10-15) �--- Presorted by Department of Local Government Finance 1 1 INSTRUCTIONS: Fit lb be filed in person or by mail J with: Filing Dates 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought �7 Must be filed or postmarked with the County Auditor or County Recorder of the county where the proper p 1 9 ,µ1$County Auditor boated on or before January 5 of the immediately succeeding calendar year. `� 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county County Recorder where the properly is boated during the twelve(12)months before March 31 of each year the deduction aught See reverse side for addMona!instructions and qualifications. App&ant teener or buyer-see on ,ce side) GIBSON COUNTY AUDITOR ill ,nrrrr�� deYsrnnr �/ /�%1 Taxmlq District ` lit.-J � .-. Y — 1 0c) — DOD )9 3 (Record nu (� Pag/�!>er Assessed value of real property as of Mortgage/Contrac� indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as Is the applicant the sole assessment date,current year assessment date,current year date of,appripyorn �r� legal or equitable owner? X777/(`'�� (//'fir° ❑ yes ❑ No If rm,what is his/her exact share of"merest? If owned with someone other than spouse,indicate with whom If name on record is different than that of applicant indicate below. Is the property in question:Annually Assessed ❑Real Property ❑ Annually Assessed • Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller Address of rtrortry 1-IC�-f.g ��°1 i cup IC) Name of assigns' Drawer NO...�01..t... Address of assigr I /„ Card NO. tl/YI Does applicant a-- ---- - - - - t? this deduction been requested If yes,state amount of deduction in Indiana? ❑Yes ❑No I I current p�yea?for ❑Yes. ❑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 fine of credit that is recorded in the county recorders office)that is the basis for the deduction. COUNTY AUDITOR Deduction approved in the amount at 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 of the aforementioned property on date application is filed. •ignatu` •. - full name 1 I - Date(mouth,day,• F. ='•ent address of pplicant(number- street o'y. -- and ZIP code) Da '1 s I O Sb ©� QIL i t 1-( ?(a(o.s Person authorized by duly executed Power of Attorney ey or by IC e-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 510,000. - -