HomeMy WebLinkAboutMortgage_Elrod --'rJ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year l
''•:r FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709(R13/10-15)
Prescribed 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
Must be filed or postmarked with the County Auditor or County Recorder of the County where the property is 0 County Auditor
located on or bef re January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the county ❑ County Recorder
where the property is located during g the twelve(12)months before Mardi 31 of each year the deduction is sought
See reverse side for additional instructions and quafificafions.
Appliranj—ICkr contract WA,-se@ r{IN on reverse side) 1
lit.-, �)l-- •LLKey'y numberr/legit dessaaiption 1` ` Record number Page number
u r1
n •s pac,— 11 — \-300 —0- b`1 .2Y1 —02-1 2V1 O 7 .0.6
Assessed .,..- . real P as of Mortgage I Contract indebtedness unpaid as of Mortgage/Conrad indebtedness paid as of Is the a N�nt the sole
assessment.-r- crush#y assessment date,current year daU J �2 ^r 6 l��O1fP7�O(�yitaba own 0 r?
No
If no,what is his/her exact share of interest? If owned with`s'oomeone other warn s7l(spouse/b spouse,indicate with whom /\
If name on record S different than that of applicant,indicate belast property in question:Annually Assessed
JJ � II '' • Bq Realll rlooperty ❑ AnnuallyAssessed
IJI�K e �) \ �J Mobile Home(IC Gt.t-7)
Name of mortgagee or contract seller �1
vl
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
OCT. 312018
C: gr—(C-rig - I �,t.
Drawer NO `� GIBSON COUNTY
a6 Mat Taxing District? Hon this deduction been requested If yes,state amount of deduction
in n�� aineont perty for ❑Yes ❑No
A i Card NO. VC 3 s a balance on the person's mortgage or contract indebtedness that is recorded in the county
re, s recorded in the county recorders office)that is the basis for the deduction.
— 243 ISCL� COUNTY AUDITOR
Deduction approved in the anatmt or. - - --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.
Sig ) Date(mouth,day,r )
XFull ' address t mberand steet state,and ZIP code) 1
61 W . �,�,u„I -vA 11 0 wens„Ikc. DO-1+Th66 s
Person authorized by duty executed Power of Attorney or by IC 9-1.1-12-0.7 / Date(month,day,year)
Address of authorized person (number and sheet coy,state,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.