HomeMy WebLinkAboutMortgage_Scales (2) >. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
4:': ^ FOR DEDUCTION FROM ASSESSED VALUATION
' State Fonn 43709(R13/10-15)
<-ii- Presabed by Department of Local Government Finance q ' �,��
INSTRUCTIONS: _ de'v r�"'1
To be filed in person or by mail. .
Filing Oates 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"hem the property'NOV 1 43 unty Auditor
located on or before January 5 of the immediate&succeeding calendar year. 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 March 31 of each year Me deduction is so
See reverse J.,: for additional instructions and qualifications.
App&ant(own contract•. _ -see on reverse side) GIBBON COUNTY AUDITOR
.r' ��y(Li��9�?�LLj� �bca(9Q,e,- M �/ Q/�� �a �m/�
Taxing DisUiU/ ,.,)mom=/Uld - a00- Ow • 7 i U poi Record n 1 l w
Assessed value of real property as of (� Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment data,omerd year assessment date,current year date qt ap¢Ixatmn legal or equitable owner?
I C-a!) TVl ❑ Yes 0 No
If no what is his I her exact share of interest? If owned with someone over than spouse,indicate with whom
If name on record is different than that of applicant,indicate below- Is the property in question:Annually Assessed
0 Real Property 0 MnualyAssessed
Mobile• 6-1.1-7)
Name of mortgagee or contract seller �-.} ! ,rs /1
Address of mortgagee or contract seller(number and street c statel,and 1(ZIIP code) --
Name of assignee or other owner or holder of moitgz I n^ , r1 b
Address of assignee(number and street city,state,e -5uS l (1--
Does applicant awn property in any If yes,what w I lt_ti/-01 6 114 ten requested If yes,state amount of deduction
other county 7
in Indiana? ❑Yes 0 No /g7Y 'es ❑No
A person is not entitled to this deduction unless; ATlra//.-L- act indebtedness that is recorded in the county
recorder's office(including any home equity line Q(.Q , _._'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/1Ne certify under the penalty of perjury that the above and foregoing informations true and Caned and that the applicant is a resident of Indiana and
owner I contract b r of the aforementioned property on date application is filed.
h ` ,,, --(ow, fug Date(month,day year)
till'ern address of applicant(numbermate,and code)
144 £ aob _s 41636
Person authorized by duly executed Paver 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$10,000.