HomeMy WebLinkAboutMortgage_Schroeder (2) '} STATEMENTFOR OFDEDUCTION MORTFROM GAGE ORASSESSED CONTRACTVALUATION INDEBTEDNESS County Township Year
_ )'0 State Form 43709(R13/10-15)
Presabed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
1.�
To be filed in person or by mail Form filed with:
Filing Data 1) Real Property:Must be completed and dated in the calendar year for which the n is sou
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. FF Q a I ' ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the u um r., .1 the county
where the properly is located during the hvehe(12)months before Mardi 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications. Nik
Apptkant(ownerw see restrip'ogs on rate side
) GIBSON COUNTY AUDITOR
Taxing District � ,number/legal description R nter Page number
N 'Q Ds-51I0
— DDD. �0/"D! '� 1 C�1 0i$
Acces M value of real property as of I Mortgage I Contact indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole •
44c:element date,arrant year assessment date,current year date of a legal or equilab a owner?
s ) ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
t name on record is different than that of applicant,indicate below. Is the property in question:Annually Acwcsed
0 Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Nacre of mortgagee or contract seller
Address of mortgagee or contract seller(number nd street ,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 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 line of credit that is recorded in the county rewrler'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 1 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.
S e�ee�..t/ Date(month,day,year)
(hum
till ' ru..4h.•cc rd mu nt(numtr+r and cheat rirw state,ynd LP code)
Person authorized by duly execute()rvw. .of Attorney or by IC 6-1.1-12-0.7 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.