HomeMy WebLinkAboutMortgage_Pleiss1
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
' FOR DEDUCTION FROM ASSESSED VALUATION
'�'^ State Form 43709(R13/10-15)
Prescrbed by Department of Local Government Finance
INSTRUCTIONS: - File Mark
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought ❑ County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly is
located on or before January 5 of the immediately succeeding calendar year. 0 County Recorder
2) Mobile I Manufactured Homes not assessed 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 deduction is sought .
See reverse side for additional instructions and Qualifications.
�s
Taxing ' •' Key number/legal desaiption Record n Page number
i�h� Cat e.� , --tos-- ss o24-coo . 6cri -big • 7n 1 1g 3) .
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the appina a sole
assessment date,anent year assessment dale,currerd year date application 03 legal or equ" a owner?
.6O OOO�- . Yes ❑ No
If no,what is his I her exact share of interest? If owned with other thanha spouse,po indicate with whom
If name on record is different than that of applicant indicate below: Is the in question:Annually
Assessed
Property 0 Annually
• 1LjE (IC 6-1.1-7)
Name of mortgagee or contract seller o l 1 l[_/-tA�1//` g�-j
Address of mortgagee or contract seller(number and sstre�e t city,state,and ZIP code) $E P 4 2018
Name of assignee or other owner or holder of mortgage ' p —
L.0.vY-r 61- \1R.v..c._ Q tL lsS wa
� :.s .
Address of assignee(number and sheet ciy,state,and z I a
�0 0\1C3 le Lo0ov . bO GIBSON COUNTY AUDITOR
t
Does applicant own property in any If yes,what county _ 'p I requested If yes,state amount of deduction
other
❑Yes ❑No .-a0 I ` \ 6' 3 k 5 ❑No
A person is not entitled to this deduction unless the 5-
44_ (� 4 indebtedness that is recorded in the county
recorder's office(including any home equity line of 4 t the basis for the deduction.
Deduction approved in the amount of
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
X owner/contrraactt buyer of the aforementioned property on date application is filed. (]� 1 . a}��
te(month,
\ Sig (avnar't1�a�►q`� 21 tins_ Da-\ "l ay,-1 •
Full ent address of applicant(number and sheet,city te.and ZIP cod
6126 N co E PTV- n I n - L19 Q .
Person authorized by duly executed Poem}of Attomey or by IC 6-1.1-12g1.7 Date(month,day,year)
Address of authorized person (number and street ay,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 310,000.