HomeMy WebLinkAboutMortgage_Sikes STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownshipYear
.fie FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 parf ento VI I Wb� P I•$W✓� 7N1 1
Presorted by Department of Local Government Finance J 1
INSTRUCTIONS:
File Mark
lb 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 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( or contract buyer-see resifi:dons on reverse side)
T g District Key number/legal description Record nu r .Page numW
v--1.0 26-\1-10 -2_0o- 00( - 001 — 2� 20) 2-23C
Assessed value property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,anent year assessment dab,current year to ofCya[' tion _{r.� legal or u e owner?
•
t no,what is his f her exact share of interest? If owned with sa/�eorre otherthine O t(Jt'— Yes ❑ No
cpmrcn,indicate with whom
If name on record is different than that of applicant,indicate below: I property in question:Annually Assessed
Real Property 0 AnnuallyAssessed
Moblle Home(IC 6-1.1-7)
Name of mortgagee or contract seller
RA 4 & 1s
Address of mortgagee or contract seller(number and 1 . •1 a .: .,)' r
Name of assignee or other owner or holder of mortgage COt
i
I �r ��91IF-11��J17] a T
of assignee(number and street city,state,and LP aJdUNU6 L A, call—
Address
Does applicanta own property in any If yes,what county? District? Has
this deduction been requested �� If yes,state amount of deduction
in Indiana?ty ❑Yes ❑No GIBSON C UNTY AUDITOR amenptntyyea?or ❑Yes ❑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 , 1, 20 20 Co :(p�r� ' 20' a�q 20
Signature s&A itch `MI - C' I V l _ Da�g ga r
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant resident of Indiana and
owner/contract buyer of the aforementioned property on date application is tiled. tit
Sip rt (a+yrers hdl narrt0) Date 6aRD ji
yay0 .
lioacts
Fug resident address of applicant(number and street city:state,and ZIP code)
Person authorized by duty executed Power of Attorney or by IC 6-1A-12.0.7 Data(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$10,000.