HomeMy WebLinkAboutMortgage_Greene (6) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
e `� FOR DEDUCTION FROM ASSESSED VALUATION oPp..50/State form 43769 par/10-15)
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`— Prescribed by Department of Local Government Finance v`-t
INSTRUCTIONS: File Mark
b be filed in person or by mail. Form 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 X County Auditor
located on or before January 5 of the immediately succeeding calendar year. �C
2 Mobile/Manufactured Homes not assessed as Real Proounty Recorder
Properly:Must file with the County Auditor of the county
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 instructions and qualifications.
Applicant/pm/sr or con resrictons on reverse side)
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Assessed value of real 1pproperty as of Mortgage!Contract indebtedness unpaid as of Mortgage!Contact indebtedness un id as of Is the applicant the sole
assessment date,current year assessment date,current year date of Pplration � legal or tillable owner?
/ ' • Yes El No
If no,what is his/her exact sham of interest? If owned with ne other oO V indicate with whom
If name on record is different than that of app&rant,indicate below- Is iiii • •.•_ in question:Annually Assessed
E1--- Property ❑ AnnualtyAssessed
•
Mobile Horne(IC 6-1.1-7)
Name of mortgagee or s contra seller t
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Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
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Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) toga 36
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GIBSON COUNTY AUDITOR
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
otter county on property for
in Indiana? ❑Yes ID 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 coned and that the applicant is a resident of Indiana and
owner!contract buyer of the aforementioned property on date application is filed.
Signature(owner's fun name) Date(month,day,ye
i adtl aPPO t(gkrm tlshe \ ate,dnd;P . fl7 \-h'/l rovi _I I 9 i
P on authorized by duty executteedd1yPower��of Attorney 000rrr bby IC et-11.1-12-0.7 1 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 S10,000.