HomeMy WebLinkAboutMortgage_Christmas (2) et . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
' ^I FOR DEDUCTION FROM ASSESSED VALUATION
—.Ali' State Form 43709(R13/10-15)S f 1' Pres abed by Department of Local Government Finance C ft r
INSTRUCTIONS: File Mark
b be filed in person or by mail. rm filed with:
Filing Dates: 1) Real Properly 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 inunedratety succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property Must file with the County Auditor of the county County Recorder
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional inshuctions and qualifications.
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Page number
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Assessed value of real property as or b Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of ap ratio--.(� legal or itable owner?
� as ou Q i Yes ElNo
If no,what is his/her exact share of interest? If owned with other th&spouse,indicate with whom
If name on record is different than that of applicant indicate below -+ . .._ questionA:Annually e HAssessed
aii)-Ay ❑ AnnualyAsCed6
1.1-7)
Name of mortgagee or contract seller , r
Address of mortgagee or contract seder(number and t city,state.and➢P code)
Name of assignee or other owner or holder of mortgage `1 ( '
GIBSON COUNTY AUDITOR
Address of assignee(number and street city,state,and ZIP code)
Does applicant can property in any If yes,what county? what Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on ent year)for
in Indiana? ❑Yes D No cli ❑Yes ❑No
A poison 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
recorders office(including any home equity fine of a-edit that is recorded in the county recorders 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 l contract buyer of the aforementioned property on date application is filed.
Signature(owners full name) Date(month,dayyear)
Fr'1Wddress or tau and street cciy,tre,and oidecAr Person authorized by duty executed Power of Attorney or by IC.6-1.1-12-0.7 Date(nrwrde 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.