HomeMy WebLinkAboutMortgage_Malone .. o A STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
a'-_ ' FOR DEDUCTION FROM ASSESSED VALUATION
S� State Form 43709(R13/10-15) Gibson Montgomery
' Prescribed by Department of Local Government Finance -
INSTRUCTIONS: FILE File Mark
To be filed in person or by mail. FILE Form filed 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 Reco fu(d3 fitu gllere the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calend r 0 County Recorder
2) Mobile/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 Ma of e h rH11e deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side) GIBSON COUNTY AUDI I OH
Olivia Malone
Taxing District Key number/legal description Record purgbg gg r P; number
Montgomery 26-17-01-400-004.119-021 / UY 7
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of I Mortgage/Contract indebtedness unpaid as of Is the applicant sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
0 Yes O No
If no,what is his/her exact share of interest? use,indicate with whom
If name on record is different than that of applicant,indicate le property in question:Annually Assessed
Real Property 0 Annually Accessed
_ coi Mobile Home(IC&1.1-7)
Name of mortgagee or contract seller I n Lu( - —
CrossCountry Mortgage, Inc.
Address of mortgagee or contract seller(number and street
75 Executive Drive, Suite 407 & 4
Name of assignee or other owner or holder of mortgage I /rl 1
Address of assignee(number and street,city,state,and ZIF --It UN�!
Does applicant own property in yy If yes,what county? ested If yes,state amount of deduction
other county
in Indiana? ❑Yes gNo I No
A person is not entitled to this deduction unless the p. ebtedness that is recorded in the county
recorder's office(including any home equity line of cn 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 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 I contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name) Date(month,day.year)
Fun resident address of applicant(number and sleet,city,state,and ZIP code)
5165 S. Banner Stone Dr., Owensville, IN 47665
Person authorized by duly executed Power of Attomey 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 hall years and a fine not to exceed S 10,000.