HomeMy WebLinkAboutMortgage_Hunt STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
.'- State Form 43709(R13/10-15) 2AC1
Prescribed by Department of Local Government Anance
INSTRUCTIONS: File Mark
b be filed in person or by malt. X Mail 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 properly is County Auditor
located on or before January 5 of the immediatety succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the county County Recorder
where the properly 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.
(owner mnupq see mstricaons on reverse side)
DKeSr-er al Read number Page number
Z °L -20I —COO 2 -O01 20 �q 2gZ8
value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,an -�-ent year date of apppcayon 6(4 I co legal o • e owner?
J\J) Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone ot2r than spouse,indicate with whom
0 name on record is different than that of apprva ' irate below: , - property in qu ' " nuaty Assessed
8\dge�q_'f fL�on „A -i '••I Annually Assessed
Name of F I ; i.. it Mobile Home(IC 6-1.1-7)
Address of mortgagee or contact seller(number and street city,state,and ZIP code) JUL 2 9 2019
•
Name of assignee or other owner or holder of mortgage
ctr
Address of assignee(number and street city,slate,and ZIP code) `7�J 0rt
GIBBON 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
other county
cep�ertY for ❑imIndia Yes ID Nocurrent ? Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's aro:tgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity tine of a edit 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 7. 1 20 0 20 20 ' 20' 20
Signature of n 1 ;fin County �� Date(month,day,year)
JIB
I/We certify'inder the penalty of perjury that the above and foregoing information and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Signaturei{ (coverers fun name) �y`�V�� Date((j mh,da1yead�FUg~�Sa-et1_6%1
and street, fee and e)� —�� t � \\11NNIIti �1 I
Person authorized by duty executed Power of Atorrmey or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of aut shied person (number and street city state,and ZIP code)
The penalties for perjury can include imprisonment up to Iwo and a half years and a fine not to exceed$10,000.