HomeMy WebLinkAboutMortgage_Hartley (2) a STATEMENT OF MORTGAGE OR
FOR DEDUCTION FROM ASSESSED VALUATION INDEBTEDNESS County Township Year
State Form 43709(R13/10-15)
• Presorted by Department of Local Government Finance
INSTRUCTIONS: File Mark
Tb be filed in person or by mail. Fonn 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 inmrcrfiately succeeding calendar year. 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 and qualifications.
Applicant(own or contract buye -see restrictions on reverse side)
Taring District Key¢tm I legaO ipton Record number Page number
bask -4Or� . a S- 1t -ng - 003• 1oo - ton 2019 It sir
Assessed value piyrzity as of Mortgage/Contract indebtedness unpaid as of Mortgage Icontract indebtedness anpaidas of Is the applicant the sole
assessment date,anent year assessment date,anent year date of� i 41 l0 O^PP�� legal or equYese TE eN
If no,what is his I her exact share of interest? If owned with so other thanan Spouse, ddindical}teewwiith whom
If name on record is different than that of applicant,indicate below l-f i =.. .._..: in 4 .ally Assessed
If: • ,pert 'in -i, Assessed
• u '! .b orrie(IC 6-1.1-7)
Name of mortgagee or contract seller
Item fr .r' O_ APR 2 4 2019
Address of mortgagee or contacts seller(number et te,and ZIP code)
•
Name of assignee or other owner or holder of mortgage atitgat—
GIBSON COUNTY AOnITOR
Address of assignee(number and sheet city,state,and ZIP code)
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? ❑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
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 2''0 20 20 - 20 ' 20' 20
S' re of County rWditor // � unry( Date(month,day,yeau)
tes4ny -a -Ill •
I/We certify under the penalty of perjury at th ve and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contra• buyer the aforementioned property on date application is filed. 1
WSgnatu wney ni Date�(a,d1 y `&
roll esides address of applicant(number and street dry.sta .and ZIP code)
' /9 f 16 1,i ► s ./ / a AD is I Z., Y7d e Date authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 • 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 S10,000. •