HomeMy WebLinkAboutMortgage_Houchin (2) `f STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
✓ -� '^ State Form 43709(R13/10-15) G V'f .n\ rr r c\1 2019 .
' Prescribed by Department of Local Government Finance l I
INSTRUCTIONS: File Mark
To be filed in perm or by mail. Fo 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. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the properly is boated during the twelve(12)months before March 3f of each year the deduction is sought
See reverse side for additional instructions and qualification.
nt(owner or contra see resuicticns ov reverse Sic )
i'1non� err.0 a • Ul(fh i n .
T Key I legal Record number Page number
t'°r rT4t b3—too q-11 —0 t9 2_01q 21
Assessed value of real p of Mot Neve/Contract indebtedness unpaid as of Mange /Contract indebtedne”3ltnpaid as of Is the applicant the sole
, assessment date,currant year assessment date,current year date of car W legal yuitable owner?
00 J— . Xl Yes El
If no.what is his I her exact share of interest? If owned with ne other than spouse,indicate with whom ,fllT�T
tf name on record is different than that of applicant indicate below e property in question:Annually Assessed
r..Annuafi'Assessed
IA\ F. i7 nil Home(IC Gt.1-7)
Name of mortgagee a contract seller S ' � i
Address of mortgagee or contract seller(number and street city,state,and ZIP code) J U N 0 6 2019
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Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code) one
,' bu
GIBSON t OUNTY AUDITOR
Does applicant own property in any If yes,what county? tMtat Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes ❑No curent yeaR ❑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
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20 2 20 20 20 ' 20' 20
Z
Signature of ty ditch ' Court Date(month, fi yeal
GYl l C$(� 1 � �I 6 ICI
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a relident of Indiana and
owner l contract buyer of the aforementioned property on date application is filed.
S .,"own s full name) 1 i _ ( Date(moltdiyet .
CI✓VA` F r address of applicant(number�and street'a•- Y cr, ard•`P e) 6 `S �r S� CD K t- 3 t
Person authorized WiEy exerted Power of Attorney or by IC 6-1.1-12-0.7 t Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)
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The penalties for penury can include imprisonment up to two and a half years and a fine not to exceed Sf0,000.