HomeMy WebLinkAboutMortgage_Norrick STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
--:, FOR DEDUCTION FROM ASSESSED VALUATION County Township Year
':;:l if- State Form 43709(R13110-15) FILE Prescribed by Deparbnent of Local Government Finance 11! AAA���JJJ File Mark
INSTRUCTIONS: 3 1!_1
To be filed in person or by mat qq pp ���4 Form filed with:
Filing Dates' 1) Real Property Must be completed and dated in the calendar year for wh�e ae2rctrtk)ys sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is County Auditor
located on or before January 5 of the 6mnediatey succeeding calendar r.
2) Mobile/Manufactured Homes not assessed as Real Property:Must fit milky-of the county County Recorder
where the property is located during the twelve(12)months before a deduction is sought
See reverse side for additional instructions and qualifications. GIBSON COUN Y AUDITOR
Apptipnt(owrrer or con buyer-see nytSon reverse side)
info y irs'i t k 4-
004 Ce�a1$/n H[ 1I 303 col. 7 number Pa r
assessment dale,amen year I of hiss unpaid as of r Contract indebtedness unpaid as of Is the appli ant the sole
appbcabon legal or equitable wvner?
o ❑ Yes ❑ No
If no,what is Ns/her set slave of interest? If iowned with someone other than spouse,indicate with whom
If nacre on record is different than that of applicant,indicate bebhr. Is the property in question:Annually Assessed
❑ Real Property ❑ AnnuallyAssessed
Mobile Home(IC 6-1.1-�
Name of mortgagee tract Seller ) VC no ,^d ? I la is
Address of mortgagee or contract seller(number and street city sate,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street dry,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 county on property for
in Indiana? ❑Yes ❑No current year? ❑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 hunre 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
%n 1
Signature of County'W— — - - - — i /U _ _ County }�' ) _ Date(montydaya-/�
I/We 4nd umation is true a and aandnd,/thhat�thee applicant is a rCres///dent of Indiana and
owner I contract! is filed.
)SignaWre(owneg ' n Date(month,day,
re:g.,d)
Full r address•
CO U( Card NO. ( l 6Xy rA/ y77 O
Person alp• ed by / Date(month,day.year)
Address of authorized person (number and street city,state,any at-cone)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. .