HomeMy WebLinkAboutMortgage_Maier (3) }_t. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
fie" , FOR DEDUCTION FROM ASSESSED VALUATION
.'"-- �-' State Forrn 43709(R 13!10-15)
‘7S- - Presalbed by Department of Local Government Finance
INSTRUCTIONS:
To be filed in person or by mail. Fprm with:
Filing Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is ht. 1
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. AAA�n� 77'' �
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of tlFaiioualyv 20
9❑ County Recorder
where the properly 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.App6ant(owl oC convad -see restrictions on me side); . ?� —
11i \ 11.J`I-- r �/' "p)i 'j�l /���r-� /� GIBSON COUNTY gU[llT(IT1t2 /tau\w0ert�''
Taxing District Key numbed!--gat Oes-ROJ-ow ' Q -0.92 Recordion 20( Ip7el`-� J
Assessed value of real property as of fir,( Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
acsos•-nerd date,cunent year assessment date,current year legal or equitable owner?
O` ❑ yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of ap indicate below r� Is the property in question:Annually Assessed
pk _ '/ a ❑ Real Property 0 M b legHoAssessed
�����////11�������{{{{��„('�IY(1 Noble Home(IC 6-1.1-7)
Name of mortgagee or contact seller
Address of mortgagee or contact seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,dry,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduct state
ion been requested If yes, amount of deduction
other county ❑Yes ID No currenton for
year?
❑
in Indiana? Yes El 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
recorders office(induding 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 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/contract buyer of the aforementioned property on date application is filed.
ttefri mare ) Date(month,day,year)
F t '�, �f i �
ppfiant(number and s6ee;'pity,state,and ZIP code)
Person authorized by duly executed Power of Attorney//y or by IC 6-1.1-I2.0.7 Date(month,day,year)
Address of authorized person (number and street pity,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.