HomeMy WebLinkAboutMortgage_Miller (48) s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10.15)
- Presrnbed by Department of Local Government Finance �pe{'�
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INSTRUCTIONS: r A .
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 Width the deduction is sought MAY 3 1Q�
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is LI County Auditor
located on or before January 5 of the immediately succeeding calendar year. p . hi Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the nty. 1 /
where the property is located during the twelve(12)months before Mardi 31 of each year the dedudial .•r.ik/'.
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
owr+erar contract buyer-see restrictions
/� i � �' e 2
Taxing District
(u�number/legal descd � r e number
(J/u.-F.(j o2lo - oa. -58 -OSo - 000. trio- o/8 'T 9y3
c'ncsrxt value of real property as of Mortgage/Contract indebtedness unpaid as of Mort gage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,anent year assessment date,cement year date of application legal or equitable owner?
is 0a El Yes 0 N
If no what is his/her exact share of interest? If owned with someone ote(bun spouse,indicate with whom
If name on record is tldfeent than that of applicant,indicate below. Is the in question:Annually Assessed
real Property ❑ Annually Assessed
•b
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller � �/ � ..� y� �• - /J
'-' �-0 KI�I�Tf�'0.�Ct
Address of mortgagee or contract serer(number and street 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)
42-f ri 0 S o I -(o . 8181 A c
Does applicant own property in any If yes,what county? What Taxing District? Has this deduc>ion been requested If yes,state amount of deduction
other r? � ❑'mIndia a ❑Yes ❑No =rent 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,yea,)
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 1 contract buyer of the aforementioned property on date application is filed.
Sigameners nr�neo ,, Date(month,day,year)
YFull residerd address of applicant(number city ZIP e)
Person authorized by duty executed Mver of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street dry,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. .