HomeMy WebLinkAboutMortgage_Ahlberg n. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
\�'- State Form 43709(par m nt o FILED
�-• � Presunbed by Department of Local Government Finance
INSTRUCTIONS:
To be filed in person or by mait filed with:
Filing Oates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought MAR 2 8 $T
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly is County Auditor
located on or before January 5 of the immediately succeeding calendar year. . my Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the 4,unty 1
where the property is located during the twehe(12)months before March 31 of each year the dedu.'. mr.:::.i/miw
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Applicant(owner or contract buyer-see restrictions on reverse side)
T g D' ' Key number/legal description, C� Record number Page number
a+ �,� _ t9- 0 - L50 et—p-o ac 9 07Q0
Assessed value of real property as of Mortgage/Contract indebridness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,wrtent year assessment date,current year date ofappliatmn legal or equitable
1 : SC) — gt-rrs 0N
o
If no.what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below is the in question:Annually Assessed
Property ❑ Annually Assessed
• Mobile Hone(IC 6-1.1-7)
Name of mizrtgra�gee or.• tract seller ,
Address of mortgagee n e or contract seller(number and street. ,state,and LP code) 10 I/�— �/✓ J
it /,
Name of assignee or other owner or holder of mortgage l.1/ / ` /I
Address of assignee(number and street,a0:state,and LP rode) rt/-1 i_n, p n1 7)77 44GZ_ a
Does applicant own property in any If yes,what county? what Taxing District? Has; N (-�Gl(�/�"/ /'T 1.—
other county on pu C. 1
in Indiana? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contrail indeoreur,ess ,isomer)in lore w..,..
recorder's office(including any home equity line of a-edit 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
ST re a County Auditor ry • Date(month,day,yevt
I/We certify under the penalty of perjury thitithle=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 fled.
.Signature(owner name) Date.(montdaag 1 n
)(9 resident address of applicant(number and street thy.state,and LP e) 1.-
(-,Cl
IDaerson
2...— f1 erg C WlCA fQ1 ,' 8 (`oAr1c-Yl rt.) �"t'11P4 �j
authorized by duly executed Power of Attorney or by IC&t.i-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,slate,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.