HomeMy WebLinkAboutMortgage_Hunter (7) �, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
c.7o„`I-- FOR DEDUCTION FROM ASSESSED VALUATION
'- State Form 43709(R13/10-15)
Prescribed by Department of Local Government Finance j
INSTRUCTIONS: �� f
To be filed in person or by mail. Form Bled with:
Fifing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought ��v�
Must be filed or postmarked with the County Auditor or County Recorder of the county where the prop",is 2 2 County Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the ••. ty , I : C• • Recorder
where the property is located during the twelve(12)months before March 31 of each year the deduction'.....f.r iiiMir
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Amoco• t(owner or contract buyer-see restrictions on reverse side)
De DAV) kir. ,A.,AhJ
Taring District Key number I legal description Record nu Page number
-rl �at,ts->L� -2 -/2 • bS- 301 - COD•S3'J— 02 q 2b1? 000r
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessmentr1 date,current yearea date of legal or equ' ble owner?
4GY'lOCL AIM i l Q V5 4D Z-- t i) Yes 0 No
If no,what is his/her exact share of interest? I owned with someone other than spouse,indicate with whom
If name on record is afferent than that of applcant,iticate below Is in question:Annually Assessed ID AnnuaffyAsssessed
• fff��Real
� Mobile Home(IC 6-1.1-7)
iaN of mortgagee or contract tel
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Address mortgagee or contract seller(number and street te,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 ❑No current year? ❑Yes 0 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 fine 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
Signatu (/.� /I A_.: 1 t—i[ J County` ✓S'� Ic� 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.
Sig ( MB am Date(month,day,year)
//1/1 _
esid address a .ant(nu and street city,state,and ZIP ) • /
/02 S. .97,n 5 Sr- /1 ivc cn✓ /A- q 76Q o
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 sheet city,state,and ZIP code)
The penalties for perjury can include imprisonment up to Iwo and a half years and a fine not to exceed 510,000.