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HomeMy WebLinkAboutMortgage_Gibson (2) �-aSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ,'"?J Coun Township Year FOR DEDUCTION FROM ASSESSED VALUATION ty State Form 43709(R13/10-15) '--- -• Prescribed by Department of Local Government Finance I TR ed in peS: - I; filed in person or by mail �,.with: Dates 1) Real Properly Must be completed and dated in the calendar year for which the deduction is YughtILI Must be filed orposhnailred with the County Auditor or County Recorder of the county where the Pict r County Auditor located on or before January 5 of the immediately succeeding calendar year. r`U' 3 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county County Recorder where the property is located during the twelve(12)months before March 31 of each year the deductizis sought. See reverse side for additional instructions and qua fifications. Applicant(owneror d see stricaons yde) NI Applicant '1t � GIBSON COUNTY AUDITOR Taxing District lS 4J I 03 - 00.a• 4 ?O- ©a 62 Retard n m s. a I � � Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole assessment date,current year assessment date,current year date of a itation legal or equitade owner? r (gip ❑ Yes ❑ No If no.what is his/her exact share of interest? If owned with someone er than spit isn,indicate with whom If name on remit is different than that of applicant indicate below. Is the property in question:Annually Assessed 0 Real Property ❑ Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller Q ,^ /"1 Address of mortgagee or contract seller(number and street,city,state,and ZIP code) Name of assignee or other owner or holder of mortgage Address of assignee(number and atreet 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 fij' air ❑Yes ❑No wr2nt yea?fo r ❑Yes ❑No n 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 recorder's 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 correct and that the applicant is a resident of Indiana and owner/contract buyer of the aforementioned property on date application is filet S a� � Date(mouthi— / day year) F r address of number and sheet city,state,and ZIP code) 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 two and a half years and a fine not to exceed S10,000.