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HomeMy WebLinkAboutMortgage_Howard STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS be'et,' County Township Year ` FOR DEDUCTION FROM ASSESSED VALUATION ��,�e �`q �'^ State Form 43709(R13/10-15) �— Prescribed by Department of Local Government Finance F �,�Z�--/�-�F. INSTRUCTIONS: Ile Mark 7)be filed in person or by mail. Form filed with: Filing Dates: 1) Real Properly Must be completed and dated in the calendar year for which the deduction Ap rgptg zoo Must be filed orpostrnadced with the County Auditor or County Recorder of the county where titre property rs 'County Auditor located on or before January 5 of the immediately succeeding calendar year. 2) Mobile 1'Manufactured Homes not assessed as Real Property:Must file with the Coon IyA(/�'- of t co ty� County Recorder where the property is located during the twelve(12)months before March 31 of each year b' ( See reverse side for addibbnalinstructions and qualfcations. GIBSON COUNTY AUDIR (owner or contract buyer- Appoint ).(f)\ c n.l_ T No^ tJctic1 7 Q Dot` \ Kei number/ description .6 --C1-o1 -404 - 000 . 39-Sm022R nu number \_� QelQ? I Assessed value of real p,upmty as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contrary indebtedness unpaid as of Is the a plicant the sole assessment date,anent year assessment date,current year date of ap lication legal o bile owner? Yes ❑ No If Co,what is his/her exact share of interest? If owned with ne other than spouse,intricate with whom If name on record is different than that of applicant,indicate bekrfr. . I property in question:Annually Assessed ,L! ,Real Property ❑ Annually A„essed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller c j 3_, 'i 2 . , Address of mortgagee or contract seller(number and ufftib city,state,and ZIP co u - Dra1$ er NO ..Name of assignee or other owner or holder of mortgage (.. , Card t\`O. • 1.��I .. - Address of assignee(number and street.city state,and ZIP code) ••. , Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requesw. .,state amount of deduction Indiana?anry ❑Yes ❑No current ear?operty for ❑Yes ❑NO .I 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 Audit Cn.mry Date(month, ay,year)) C� (dam � Aid �hsr� . 4 re /y I/We certify under the penalty of perjury a bov nil foregoing information is true and correct and that the applicant' a residehi of Indiana and owner/contract buyer of the aforementioned property date application is filed. kSignature(owner's full name) (month,day,year) Fu0 address of app (number d steer. state,a ZIP code) k• I & �� 601 C P r LSc 0 vine- On -4 6 � - Person authorized by duly executed Pipe&of Attorney or bf IC 6-1.1-12-0.7 Dal(_th�y red Address of authorized person (number and street city,state,and ZIP code) 1• I C-� The penalties for perjury can include imprisonment up to hvo and a half years and a fine not to exceed$10,000.