HomeMy WebLinkAboutMortgage_Montgomery (7) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
• �1- State Fam 43709(R13/10-15)
�-' Prescribed by Department of Loral Government Finance
INSTRUC11QNS: LEDFile Mark
7o be filed in person or by maiL Fonn filed with:
Filing Dates- 1) Real Properly Must be completed and dated in the calendar year for which the d
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. ►►A,I�� ,1 n�tf11 i��
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County HWNortffti 4blrh1y D 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 instructions and qualification. ��—
Apprh•n (ownerr or contract hover-see restrictions on reverse side)
A o py)j phtj, GIBSON COUNTY AUDITOR
Taxing D,'striS K umber/legal(Iescdption Record number Page number
2(0.j2-tier 3 - col. 300 - D28 20 IS Oil I
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as Is the ap Sole
assessment date,current year assessment date,current year date of anol�tion_ legal
. . .. 4�t�43,jt� / DO
eg or equ' amen
,Ilos Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,intricate with whom
If name on record is different than that of applicant,indicate beam. Is thsgtoperty in question:Annually Assessed
Property 0 Annually Assessed
• Mobile Home(IC 6-1.1-7)
Warne Ra mortgagee orrd i sellrl
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
x
Name of assigns r owner or holder age
Address of assignee(number and street,dry,state,arhp . e
o M /r 1((1/I�fl �f ✓/L(1/ u 7(p70
Does applicant own properly in any If yes,what county? Waal Taxing District? Has this deduction been requested If yes,state amount of deduction
countyother in on property
❑Yes 0 No current Yes 0 No
A person is not entitled to this deduction unless the person has a balance on the person's ma gage 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 duou.cd 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.
\c,Si re(owrrer5 full naryet,\ A0 Date(xxxvrNr,day,year)
Fur • dress of applicant(number d street • ate,and ZIP code)
Person authorized by duly executed Power of Attorney or by IC 5-1.1-12-0.7 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 Iwo and a half years and a fine not to exceed$10,000.