HomeMy WebLinkAboutMortgage_Jones (5) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ArilINLi `at.hii, Year
FOR DEDUCTION FROM ASSESSED VALUATION _ .� •, =�^
tom- State Fonn 43709(R13/10-15)
Prescribed by Department of Local Government Finance
AUG 1 3. i
INSTRUCTIONS: - Fg�taarlc
7b be filed in person or by mail rm with:
Fling Dates 1) Real Properly.Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or pos marked with the County Auditor or County Recorder of the county where the County Auditor
located on or before January 5 of the immediately succeeding calendar year GIBSON COUNTY At+�ITOR
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county U Court Recorder
where the property is located during the twelve(12)months befae March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
or contact Wryer-see restrictions on rse side)
Ti+ aw J �
Toxin rstictc F Key number/ description Record n r Page number
2L. - « - 07 - 103 - 003. s ? 8- og- 8 3141
Assessed value of real property as of Mortgage/Contract bdebtedness unpaid as of Mortgage/Contract indebtedness unpaid of Is the applicant the sole
assessment date,current year assessment date,current year date of application , legal or equitable owner?
I if ?7.5 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with sorneonelother than spouse,indicate with whom
If name on record is di ferent than that of applicant,indicate below. Is the property in question:Annually Assessed
❑ Real Property ❑ AnnuallyAssessed
' Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller p S
•Address of mortgagee or contract seller(number and street ay,state,end ZIP code)
Name of assignee or other owner or holder of mods
Address of assignee(number and street dry,state, _1x•7/
Does applicant own property in any If yes,what Dra\Yel- 1r0 1Vx oeen
requested If yes,state amount of deduction
other in Indiana? ❑Yes CI No q/ ( f / IYes 0 N
A person is not entitled to this deduction unle: Card NO. �( 1 !tract indebtedness that is recorded in the County
recorder's office(including any home equity Ii, at is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount at
20 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.
C :, re(owners lull name) / Dale(month,day,year)
/ r i ' , - A/ A
resident address of.... - tuber and street,city,state,: d ZIP code)
91 X a.. ,,ett, i11 vMe-e--Cad .,ill'-' Y 7 4447 0
Person authorized by duly- -• -d Power of Attorney or by IC 6-1.1-12-0.7 I Date(month,day,year)
Address of authorized person (number and street dly,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a hat years and a fine not to exceed 510,000.