HomeMy WebLinkAboutMortgage_Brackett (2) re STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
t FOR DEDUCTION FROM ASSESSED VALUATION
• State Form 43709(812/5-14) Gibson Ft.Branch
s„5 Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. Fonn filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year br which the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year ❑ County Recorder
2) Mobile/Manufactured Homes not accessed 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 deductbn is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner a contract buyer-see restrictions on reverse side)
David Brackett
Taxing District Key number l legal description Recorl mb Pgnwnt--
Ft. Branch 26-19-18-101-001.169-026 VQ-J(lI//l���ll ns-k
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?
ap E/If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate yu
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
0 Real Property ❑ pit1
JMbbll 1.1-7)
Name of mortgagee or contract seller
Peoples Trust & Savings Bank
Address of mortgagee or contract seller(number and street.city,state,and ZIP code) GIBBON COUNTY AUDITOR
7199 Parker Dr., Newburgh, IN 47630
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 a If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county
In Indiana? ❑Yes No on property for r ❑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 once(including any home equity fine 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/contrac • er of the aforementioned property on date application is filed.
Signature(owner- m-' ...m...mar„ Date(month,day,year)
.4 4 itL%/ Apr
Full resident a•: •ss of a•plicant( umber a •s et.city,state,and ZIP code)
804 Creek Dr., Ft. Branch, IN 47648
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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 510,000.