HomeMy WebLinkAboutMortgage_Gritton (2) IS�T STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
L ~` FOR DEDUCTION FROM ASSESSED VALUATION \\ r�
_v,`-'- State Form 43709(R13/10-15) On� `` r n 2Iv'
Prescribed by Department of Local Government Finance V L. �-1, I ` I
INSTRUCTIONS: File Mart
To be filed in person or by mail. Form filed with:
Filing Oates 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 (t[I County Auditor
located on or before January 5 of the immediately succeeding calendar year. y/� 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(owneror contract buyer-see restrictions;]jn
on reverse side)
J e�T 1 E/ 1....-c KeWnumber
Taxing
Record numberPage number
� . -2-6 - 2(6 300r(r)02' ► R-Q2 -i 1019 ' 2_y4z -
Assevsed value of real property as of age/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the pl' nt the sole
assess date,current year assessment date,current year date of cation 4 legal or Liable owner?
SI Yes 0 No
If no,what is his I her exact share of interest? If owned with ne over than spouse,indicate with whom
If name on record is different than that of applicant,indicate below s th property in question:Annually Acv+csed
F/L v 1 ) eat Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller /
t 1l—c u .
Address of mortgagee or contract seller(number and street city,state,and ZIP code) J U N 2 .0 2019 •
•
Name of assignee or other owner or holder of mortgage nnemevga —
Address of assignee(number and street city,state,and ZIP code) GIBSON COUNTY AUDITOR
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
n �7 ❑Yes ❑No current tyear?fo r ❑Yes 0No
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
recorders office(mcluding any home equity fine of aedit 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 %v.\ 20 20 20 ' 20 20
Signature of County it roitn Date(month,day,year)
.I I\ C • t1 G -zo - vG
I/1Ne certify under the penalty of perjury that the abo an foregoing information) and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed. + /-�
\/ Signature(owne'r�]_juu name),a--G., ,,er ant street t- p`- 'I-.-/r�- Date�f1j6 •-• to—
(1a(^�`e a q
/Jt\ f r I�n_t/ail d l 1W 1 I"J tstQi; ttee\. LP t�3 r .4 `-� 1 r1 V""' ` 1 ojoi �n
erson authorized by duty executed Power of Attorney or by16)1.1-12-0.7 "bate(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. .