HomeMy WebLinkAboutMortgage_East M.,. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
i FOR DEDUCTION FROM ASSESSED VALUATION � -
State Form 43709(R12/6-14)
Prescribed by Department of Local Government Finance ;a
INSTRUCTIONS:
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To be filed in person or by mail. Form flied with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where tpltity i52O18 ❑ County 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 d tion.is —
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side) GIBSON COU IY AUDITOR
Riiank Eb c-�-
Taxing District Key number/legal description Record number Page number
6-11- Ili- DO I- 000 . 1099- oaa / 6-/3cHe
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
7S/ 7S-1 - QO
12- Yes 0 N
If no.what is his I her exact share of interest? 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
R-Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
6.SF Mop-I��zQe Cor oora-h'on
Address of mortgagee or con t s (number and sheet.city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,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 Qt-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 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 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 net's lull name) Date(month,day,year)
dig —
Full resident address of Mapplicant(number and street,cciity,state,and ZIP code)
Person 3oci IN . duly e teQ P�we`r of rAtlorney Or by 6-1.1-12-0.7 0 n svi e, 1 L17( ( S Date(month,tlay,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$10,000.