HomeMy WebLinkAboutMortgage_Lintzenich STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION r1h
�'- State Foos 43709(R13/10-15) YJt 19)Sr, :j-1� . _ �O 11
�- Presorted by Department of Local Government Finance V1 Y� 1 1 ��(JJ�yI
INSTRUCTIONS: _ File Mark
To be filed in person or by mail. Form 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.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county 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 qualifications.
Applicant(owner or contract buyer-see on reverse side) �l�� n�1
,S#vwn n on
KC I\ _number
age number
T �e�r1C�^ 2 Key 6 �q al q �a �z.41
R201 t P0001 .
Assessed real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the applicant the sole
asrncmerd date,anent year assessment date,current year date of pI c0 legal or itable owner?
rsb o� Yes ❑ No
If no,what is his/her exact share of interest? If owned with acne other than15pouse,indicate with whom
If name on record is different than that of applicant,indicate below: property in question:Annually Assessed
( � Real Property Mob Home(IC�G1.1-7)
Name of mortgagee or contract seller gggpp JJ�JJII
Suck \�Xll� . FI
Address of mortgagee or contract seller(nu and street city,state,and ZIP code)
APR 1 1 9019 _
Name of assignee anther owner or holder of mortgage
Address of assign O2 0 /.% - 0 0 0 I
Drawer NO GIBSON COUNTY AUDITOR
Does applicant c )istrict? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? I current year? ❑Yes 0 No
A person is not' Card
aI'd NO. on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office /the county recorder's office)that is the basis for the deduction.
INTY AUDITOR
Deduction approved in the amount of
•
20 20 20 20 20 ' 20' 20
Signature of County/U.0Ra County - Date(month,day,year)
Shem& STMi� y'I1-1g1
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 I contract buyer of t rementioned property on date application is tiled.
S' rreYs!ue name Date(month,day,yea
Xy-I1 -V1
Furl restden of a pe t(num city,state,and LP code)
2E11 E 1131 sfh ? Malin- ) - 43-C 43
Person authorized by duly executed Power ofiney or by IC 6-1.1-12-0.7 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.