HomeMy WebLinkAboutMortgage_Gipson (2) STATEMENT OF MORTGAGE OR CONTRACT I D SS County Township Year
4 FOR DEDUCTION FROM ASSESSED VA N �j ( (�
�" 1 State Form 43709(R13/10-15) G I hCr�/1 �^.n 'r '""',1 L� I(�
,,, I. Prescribed by Department of Local Government Finance �I JJ W��ff.• �' 1 �J( ' / lri/
INSTRUCTIONS: `I,A`� 12p18 File Mark
To be filed in person or by mail. lv` Form filed with:
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for which th. . tan is sso�ught.
Must be filed or postmarked with the County Auditor or County Rec.•.e •<'j)_',., fitivi 6M`the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding cal-i.l" 'Ga -(Y P` ❑ County Recorder
-2)Mobile/Manufactured Homes not assessed as Real Property: h'he County Auditor of the county
where the property is located during the twelve(12)months - 0 arch 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictiorivin reverse side)
Richard K. Gipson and Brittany Gipson
Taxing District Key number/legal description R�,rd nu es, Page number
Montogomery 26-17-09-200-005.147-021 /8- '/ 7
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,Ppuitable gmtper?
106,600 126,074.00 LJ Yes LJ 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
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Hometown Lenders, LLC
Address of mortgagee or contract seller(number and street.city,state,and ZIP code)
310 The Bridge Street, Huntsville, AL 35806
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 y 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 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 1 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.
Sign,(owne f 0•-me) c- I • Date(month,day,year)
/ ..,.sf S - 11LV.t_ .e —-4!...--5. a 05/09/18
Full resident address of applica (number and street.city,state,and ZIP code) 11
9626 Winyard Place, Owensville, IN, 47665
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person(number and street,city,state.and ZIP code)
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