HomeMy WebLinkAboutMortgage_Folsom (3) ,�5 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
E},l�J' FOR DEDUCTION FROM ASSESSED VALUATION •
• '('- State Form 43709(R13/10-15)
---= Presatbed by Department of Local Government Finance
INSTRUCTIONS: .. - File Mark
Tb be filed in person or by mail. Fonn 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 Auditor or County Recorder of the county where the property is ❑ County Auditor
orated on or before January 5 of the immediately succeeding calendar year ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property: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_�th.ye,deduction is sought
See reverse side for additional instructions and quafifrcations, i''d. i t —
Applicant(owner or dbuyer.-see1 e resrrr-,^^^^--•°^^side)
is
Lann ow`l . .
Taxing - Ney number/legal description Record number Page nu r
' � . I26—‘ 8-11-401 -con . 628 -O 2f, . 2o\8 l s �-
Assessed value of real property as of Mort gage/Contact indebtedness unpaid as of Mortga e I Contract indebtedness unpaid as of Is the applcant the sole
assesvrent date,current year assessment date,current year date of Ppl' r, legal or equitable owner?
O O ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with ne�Wte thin spouse,indicate with whom
tf nacre on record S different than that of apprxant,indicate below. Ls.. 1
i I
I . c �� S-(IC 6-1.1-7)
Name of mortgagee a contrail seller _ (\��y�0
19 Address of mortgagee or seller(number and sheet,city state.and�~code) �IJ r7 6 ?n 1 g
, ___-----
Name of assignee or other owner or holder of mortgage
GIBSON COUNTY AUDITOR
Address of assignee(number and street,city state,and ZIP code) ^ 6_fig_ i- o 1 -00C , 6� ��
other county applicant own property in any If yes,what county? Mat District? Has this deduction been requested I If yes,state amount of deduction
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 ma 2- 0 1 g _ /5 V 7 T ty
recorders office(including any home equity line of credit that is recorded in the county record.
COUNTY AUDITOR_ _ _
Deduction approved in the anountot Drawer NO
/ 20_ 20 20 20 Card NO.
Signature of County Audits - County • - __
(
/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.
S re(owners ffuull'name) �.. ^'�]`/'-/ Date(month,day,year)
X F�r N F tI L rWCC�r v asd.aJRcode hit.
J 1 forff rein del
Person authorized by duty executed Power of Attorney or by IC 6- .1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet city,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.