HomeMy WebLinkAboutMortgage_Gatton (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
13 FOR DEDUCTION FROM ASSESSED VALUATION
State Fonn 43709(R13/10-15)
Presabed by Department of Local Government Finance
INSTRUCTIONS: . _ File Mark
lb be filed in person or by mail. Form sled 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 Authto(or County Recorder of the county where the property is ❑ County Auditor
boated on or before January 5 of the immediately succeeding calendar year ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the county
where the properly is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
t(awver err see reverse side)
Dish Key tuber I legal desoepeon Record number Page number
yoi;, ^ • 6- 20 -02--3orjooQ . 015-o01 2,04 2608
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mcrtgag-/Contact indebtedness unpaid as of Is the applicant the sole
assessment date,anent year assessment date,current year date of-W., '.• legal or equitable owner?
• • 6 Q O ❑ Yes ❑ No
ll m,what is his/her enact share of interest? If owned with •. -•ne oth: • - spouse.in. •!= A.. •m ? 1 .
1
If name on record is dMered than that of applicant,indicate below: Is mperty in gqueston:AnnuallyAssessed
Real Pre"v" bbC
1.1-7)
Name of mortgagee or contact seller }lj-�1 +�.rI.SJ`1 •
Address of mortgagee or contract seer(number and state anal ZIP rode) N'll24i}"•i
GIBSON COUNTY AUCITOR -•--
Name of assignee or other owner or holder of mortgage -
Address of assignee(number and street city,slate,and ZIP code) • ��/f/�//X('/
Does applicant own property in any If Drawer NO l/` `-'(V
other county yes,what county? What Taxing District? (/ on
in Indiana? ❑Yes ❑No 1- 3-1 Q •
A person is not entitled to this deduction unless the person has a balance on the pars Card N O 6;17‘e°6-1- aunty
recorder's office(including any home equity line of credit that is recorded in the count S-`
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Signs. - of County Audi•. County - Date(month,day,year)
I We .= ' unite,the pe -Ity of perjury t the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
• er f r .ct b• -r of th= -foremen property on date application is filed.
I S'• at re(ow : s MI )rue) x Dlfititsith.day,ye
—•e • - f -r and street oily,state.anti 97 code)
9 80 •.._ sSo S t AJ&AAlD (.-�-r-; -�N 476e
_ •n authorized• • executed Power of Attorney or by IC 5-1.1-12-0.7 Date(month,day,year)
'Address of authorized person (number and street oily,state,and ZIP code)
The penalties for perjury can include imprisonment up to Iwo and a half years and a fine not to exceed$10,000.