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HomeMy WebLinkAboutMortgage_Krug (2) x STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year art"?.:*- FOR DEDUCTION FROM ASSESSED VALUATION �'� Stare Fonn 43709(R13/10-15) �- Prescnbed by Department of Local Government Finance �, INSTRUCTIONS: pit)* To be filed in person or by mail t g- rm filed with: Filing Dates 1) Real Property.Must be completed and dated in the calendar year for which the deduction i hug Must be filed or postmarked with the County Auditor or County Recorder of the county whim the properly is 20\ ❑ County Auditor located on or before January 5 of the immediately succeeding calendar year. (1F C 3 ❑ County Recorder 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor oftlre county where the property is located during the twehe(12)months before March 31 of each year the deduction is so t See reverse side for additional in and qualifications. r Applicant(owner tract buyer-see re on reverse ) `f..1 -r .TUb11 O R r GIBBON COON,Y Taxing District Key /legal description V Record number Page number 6—I �—.© I • L. D Y-OD D V58 oat, 2-0 IS 4t7-4 Assessed value of real property as of ortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole assessment dare,aurerd year assessment dare,current year date of application legal or equitable own& . 5) 150 ❑ Yes ❑ No If no,what is his/her exact share of interest? If wined with someone other than spouse.indicate with whom If name on record is different than that of applicant,indicate betowt Is the property in question:Annually Assessed ❑Rea/Property 0 AnnuallyAssessed • Mobile Home(IC 6-1.1-7) Name of mortgagee or contact seller f T `1 C U ' Address of mortgagee or contract seller(number and scree;city,state,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 county on property for in Indiana? ❑Yes 0 No current year? ❑Yes ❑No A person is not entitled to this deduction unless theperson has a balance on the person's mortgage or contract indebtedness that is recorded in the county recorder's 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 1 contract buyer of the aforementioned property on date application is fled. St i hil,1t e 1 k! Date(month,day,year) �III�1)1 It 11\(nu and street city,state,and ZIP code) Person authorized by duly executed ' of Attorney or by IC 6-1.1-12-0.7 Date(month,day,yea!) Address of authorized person (number and sheet city,state,and ZIP code) The penalties for perjury can include imprisonment up to two and a haff years and a fine not to exceed S10,000.