HomeMy WebLinkAboutMortgage_Lloyd #`x,?a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
=„ FOR DEDUCTION FROM ASSESSED VALUATION
aState Fonn 43709(R13110-15)
Presatbed by Department of Local Government Finance
INSTRUCTIONS: _ File Mark
To be filed in person or by mail. Fonn filed with:
Filing Data 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought
Must be Med or postmarked with the County Author or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the irmnediately 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 the deduction is sought
See reverse side for additional instructions and quafrficat ons.
Applicant(owner or contract buyer-see restrictions on reverse side)
�Q.meS d • rcol> (1C- Uo9 c •
Taxing District Key number/legal description Record number Page number
PoLkov-anA)'�' a�- tt- \\ - \ oO- OO'-l. ` �a\ oaf /j8 a111�
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid agof Ls the applicant ttte sole
ac«ccment date,aural year .assessment date,airrent year date of application legal or equ a owner?
•
isDrl 000 Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than cprvrce,indicate with whom
It name on record is different than that of app&cant,indicate below. Is the property in question:Annually Assessed
[T-Re TTsroperty • Ann -I Assessed
i .. . s 1.1-7)
Name of mortgagee or contract se llerr_ L WI
EV c\ cis�l'\ C r n c. c l'd ' J
Address of mortgagee or contract seller(number and street city,state,and ZIP code) AUG 2 9 2018
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
• GIBSON COUNTY AUDITOR
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other
county
❑ °`'mIndiana? Yes El No current yr? ❑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: "-`--"-
COUNTY AUDITOR Deduction approved in the amount of � ��``�'
� I
Drawer NO CCC°--
20 20 20 20 2 r�
Card NO. CQ�/
Signature of County Auditor County • -
f
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.
Signature( s full name) Date(month,day,year)
Z7r address of app� t(number Oe,/
street city,crate,and ZIP code)
X 02 Li 1 ST ! �crt<-e W, 7470
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 iwo and a half years and a fine not to exceed S10,000.