HomeMy WebLinkAboutMortgage_Bruce (11) ;; STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
raj? FOR DEDUCTION FROM ASSESSED VALUATION
_-.__ '^ State Form 43709(R13 1 10-15) FILED
' — Presalbed by Department of Local Government Finance
INSTRUCTIONS: •
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought APR 2 2D18
Must be filed orpostmar/ced with the County Auditor or County Recorder of the county where the property is CJ county Auditor
located on or before January 5 of the immediately succeeding calendar year Cunt corder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the countyy e co
where the papetty is located during the twehe(12)months before Mardi 31 of each year the deduction is so
See reverse side for additional instructions and qualifications. G I BSO N COUNTY AUDITOR
Apphrant( or contract buyer- restrictions on siide) �� .� gyp...
Sl-2.e{a- e .a.0 �.R`S>��GXa tJ 1(
TvDistrict number!legal description Record number Page number
@ t >U_,IC.514D a -- ()`1- -3C) coo, A55 -oaa aol 13 (43
Assessed value of real property as of Mortgage!Contract indebtedness unpaid as of Mortgage!Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
3£) ba C7 Wes ❑ No
If no,what is his/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
14)Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller - .
E. (4 —
Address of mortgagee or contract setter(number and street city,state,and ZIP a'
m
Nance of assignee or other ovmer or holder ofmottgage Drawer NO ��1 L�
Address of assignee(number and street dry;state,and ZIP code) - / . I n
Card NO. �/
Does applicant awn property in any if yes,what county? What Taxing L no/ O . a amount of deduction
other county ov(
in Indiana? ❑Yes No
A person is not entitled to 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 coedit 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!contract buyer of the aforementioned property on date application is filed.
Sig ... : owner's full name) _ Date(month,day,year) -
1
Full =••_.address app&ant(nun°�and street state,and LP code)
0 /1�— , a Q-4-1t )7 74/ rf7 b4a(o
Person authorized by d executed Power of Attorney or by IC 6-1.1-12-0.7 / Date(month,day,year) . •
Address of authorized person (number and sheet rat slate,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.