HomeMy WebLinkAboutMortgage_Ewin (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
k 44 FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13 f 10-15)
`- Prescribed by Department of Local Government Finance
INSTRUCTIONS: FT Ie M
To be filed in person or by mail.
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 courtly where the property is JA N iE linty Auditor
boated on or before January 5 of the immediately succeeding calendar year. `Cc aunty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is boated during the twelve(12)months before March 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Appli-nt(owner or contract buyer-see restrictions on reverse side)
aria j L&fin GIBSON COUNTY AUDITOR
Taxigu.strictba --- Key number/legal description Record number Page number
IU2lSji 26- 20-2' - Zoo —COD i5/2-00/ ZOO 303
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage 1 Contract indebtedness unpaid as of Is the applicant the sole •
acvccment date,current year assessment date,assent year � date of application /' legal or a owner?
J IflQf4Ctn C APSC .$S) oco Yes D 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 afferent than that of applicant,indicate below: Is the property in question:Annually Assessed-.
❑Real Property ❑ Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgag or contract seller l/,7'1 _
u P in
Address ofcontract Wetn anAstreestlfy, istate,and ZIP code)
QA2 ,L.A £w..1:3)
Name of assignee or other owner or holder of mortgage
. r Address of assignee(number and street city,state,and ZIP code) - I
• Does applicant own property in any If yes,what county? What Taxing District? Has this de
• other county
in Indiana? ❑Yes ❑No currrent yeaR U Yes U No I J
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 approvedn 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.
XSigfiattire(owners hill name) Date(month,day,year)
/LOB. A ,
yFull resident address a:fxant(number and street city state.and ZIP code)
,3Sq l; 90o S E/b. Jjd _TM 47(o l-2--
Person authorized by day executed Power of S or by IC 61.1-12-0.7 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.