HomeMy WebLinkAboutMortgage_Sisk Sr s.n° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownship
' FOR DEDUCTION FROM ASSESSED VALUATION 1Year
--'% State Form 43709(R12/6-14) (1 930n Vim-. t oki aoFJ
S u `., Prescribed by Department of Local Government Finance Jtf) 1(,�J�'1,JY•j� l-I
INSTRUCTIONS: File Mark .
lb be filed in person or by mail. F filed with:
Filing Dates: 1) Real Property 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 County Auditor
located on or before January 5 of the immediately succeeding calendar year. 0 County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property: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 end qualifications. _
Applicant(owner c contract buyer-seg(estrig(orlt on reverse
I(t/ �pside
,n11QA �f . c - X an to SI Sc
Taxing stft Key number/
Record
` --tV l - 31200g. 3II0��� °
Assessed nibs ofrt of Mortgage/Contract indebtedness u of / e Is the applicant le
Mardi 1,current year March ,current year date of application legal ridable owner?
Yes ❑ No
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- • I property in question:Annualy Assessed
Real Property ❑ Annually Assessed
i 1 Mobile Home(IC 61.1-T)
Name of mortgagee or contract seller ti
I
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
APR 8 2019
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street.city,state,and ZIPcode) �� -
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
other county on property for
in Indiana? ❑Yes No current year?
El ❑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 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) .
She 9.ALCM VI ell 4 ,Op
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.
Signature(owner's tuft na`oee) r p n 'Date(month,day,year)
a-n.r< P 1 ,_,pi —e ali-e or - 3- 2 8- /9
Full resident address of applicant(number and street city state, d ZIP code)
Person authorized by duly executed Power of Attorney or by IC 8-1.1-12-0.7 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 S 10,000.