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HomeMy WebLinkAboutMortgage_Gehl � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year i. ? 4 FOR DEDUCTION FROM ASSESSED VALUATION p �y� �j Stats orm 43709 10-15) riotGO��• Prescribed by Department of Local Govemmeni Finance INSTRUCTIONS: To be filed in person or by mail Form filed with: Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sough(jUN j 3 20 9 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 o/the immediately succeeding calendar year. County Recorder 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of4y county4 where the property is located during the twelve(12)months before March 31 of each year the ded :iUt +JgT��r See reverse side for additional instructions and qualifications. GIBBON COIlNTV AUDITOR Applicant(owner or contract buyer-see restriction on reverse side) T-Yany A . Get, I Taxing District Key number/legal description Re number Paz u r at,- a oK- 4903- ooa . Nsp-oa8 O 1 (1 Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole assessment date,current year assessment date,current year date of application legal or equitable owner? / 3 7) , © 0 Er 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 the property in question:Annually Assessed [rReal Property ❑ Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or convect seller M0(-1-cvae Masito- of 5ndl'alla , Znc. Address of mdqgageo.er contact seller(number and street,city,state.and ZIP code) Name of assignee or other owner or holder of mortgage 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 requested If yes,state amount of deduction other county w on property for in Indiana? ❑Yes L'7 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 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 Audito ()% ii / County Date(month,day.yeapt irw. I/We certify under the penalty of perjury that the above and foregoing information is a and correct and that the applicant is a resident of Indiana and owner I contract buyer of the aforementioned properly on date application is filed. Signature owner's full name) A eszt Date(month,day,year) KO Full resident lb of aicant(number and street city,state.and ZIP code) 1-1o3 "Map( Ave. , Princeton, ThJ Lr �)1 O Person authorized by duly executed Power of Attomey or by IC 6-1.1-12-0.7 Date(month,day,year) Address of authorized person (number end 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 S 10,000.