HomeMy WebLinkAboutMortgage_Michels .canr.,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
Cj._-_ % FOR DEDUCTION FROM ASSESSED VALUATION //
• State Form 43709(R13 1015) U34n r09
. Prescribed byby Department of Local Government Finance a
INSTRUCTIONS: File Mark
To be filed in person or by mail. Form tiled 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. 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.
Ap icant(owner or contract buyer-see restrictions on reverse side)
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Iv; Key number/legal description J Record number Page numbe
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Assessed value alr petty as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,cu year assessment date,current year date of application / �� legal or unable owner?
3/ y .SD• 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: Is a properly in question:Annually Assessed
Real Property DAnnually Assessed_
Mobile Home(IC 6 1.1-7)-
Name of mortgagee or contract seller �/��
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Address of mortgagee o contract seller(number and s` ff,city state,and ZIP code)
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Name of assignee or other miner or holder of mortgage (?
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Address of assignee(number and street.dry,state.and ZIP code) ''jj((�� q
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction beef r)4eL3 G`j1 ,,state amount of deduction
other county p ❑
on property for
in Indiana? ❑ i Yes W No current year? yes ❑No _--
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contrac' fdebted•_,ss-thet 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 -GI,. • s1:ur Hle deductitorr
COUNTY AUDITOR GIBSON CoD'4T ' "
Deduction approved in the amount of:
20 \.20.,R5kg\A,20 20 20 20 20Signature of County A i, V `111 ......)
Cou 1 Date(monrhr)I/We certify un er the penalty of perjury that the above regoing information is true and correct aJo ;
It at the applicant is a re den of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signal e wn s full name) •" C _ / Date(month,day.year)
Full r dent address of appacant(number and street,dry,state,and ZIP code)
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Person authorized by duly executed Power tetfAttomey or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,dry state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 810,000.