HomeMy WebLinkAboutMortgage_Blake +i, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
;e& a' FOR DEDUCTION FROM ASSESSED VALUATION
• r i 11 State Form 43709(R 13/10-15)
` ems' Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail Form tied 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 ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file wrth the County Auditor of the county
where the property is located during the twelve(12)months before March 3/of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Donn H s M . Rlctke
UinT g District Key number/legal description Record number Page number
kkaCrI NA,\ et • at° - l- oi - e-103 - oo0 . ain - oaf le,-5is!
Assessed valued real property as ol Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment dam,current year assessment date,current year date of application� r�� S f� legal or equitable owner?
I v nro l st . cc I9'Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse.indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
Q'Real Property ❑ Annually Accessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller F II- 11
jia,nSVi IIr' TP(��h �r_s CCU
Address of mortgagee or contract seller(number and street.city,state,and ZIP code) r1!!'' pp
Name of assignee or other owner or holder of mortgage Rf C 2018
Address of assignee(number and street,city stale,and ZIP code)
GIBSON Clfirry AtI;,IT` R
Does applicant own properly in any It yes,what county? Nfiat Taxing District? Has this deduction been requested If yes,state amount of deduction
other county �,/ on property for
in Indiana? ❑Yes t�J No current year? ❑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
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 I contract buyer of the aforementioned property on date application is filed.
J Sign owner's full name Date(month.day,year)
/o let 4 ;t. _-n , Ia - aD -tg
Full resident address of applicant(number and street.city.state.and ZIP code)
305 Gies-h/if(r.i 01. )) Otiseinsv;llf Tt-\ intocos
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,slate.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.
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