HomeMy WebLinkAboutMortgage_Paul a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
0 i;li FOR DEDUCTION FROM ASSESSED VALUATION
- State Fonn 43709(R13/10-15)
�- - Presatbed 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 hi 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 ❑ County Auditor
located on or befare January 5 of the immediately succeeding calendar year. 0 County Recorder
2) Mobile I Manufactured Homes not assessed as Real Properly: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.
App6rantOwneror contract buyer- sbicdanson : . `
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Taxing District Key .r. .- Record rumba a number
(0 - 1k - 35-3OD- OQ\.933-0R/1 Ni v7 d %• U/3
Assessed value of real property as of Mortgage/Contract aiebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of 4r the applicant the
acmc^-red date,anent year assessment date,current year date of legal or equitable owner?
�1 .�&DO- - ` .6; a Yes 0 No
If no.what is his/her exact share of interest? gowned with someone other than ,,r:I/Ni•5:t RA P;.
GIBBON COUNTY AUDITOR
If name on recal is afferent than that of applicant,indicate below Is the property in question:Annually Accrcc+d
❑ Real Property ❑ Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller -"Jf1' J
Address of mortgagee or contract seller(number and stestate,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
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 in Indiana?county
❑Yes 0 No current on ear?for ❑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
recorders office(including any home equity line of credit that is recorded in the county recorders office)that is the basis for the deduction.
COUNTY AUDITOR
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 coned and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
ig re(o I )r) -a/ J Date(nrwRlt day,year)
d I O of app (number and sage;city,sate,and,3/P r�
Person authorized by duly executed Smey or by IC 6-1.1,--1122-0.7 1�1,\yjA Date(month,day.yea,)
Address of authorized person (number and street city,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a hat(years and a fine not to exceed S10,000. • - -- —--