HomeMy WebLinkAboutMortgage_Guinto (2) "n. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
• 'I' .s FOR DEDUCTION FROM ASSESSED VALUATION rl
s State Fonn 43709 Rf3/10.1 V
S , I Prescribed by Department of Local Government Finance 5i 1/4� ? ` k 1
INSTRUCTIONS: File Mark
b be filed in person or by mail. Fo led 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 property is located during the twelve(12)months before Mardi 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Aeolic/aver
roor'contract buy/e�'-see on reverse side)
G.t�y�/ k3 IndlAY\ _
Taxing v 1 - 4nymber/Se, l' 'zotA_0co. 168 -o2S Record. Pa —
Assessed value of real property as of 6 Mortgage I Contract indebtedness unpaid as of Mortgage I Conbrct indebtedness un as of Is the jjj aaant the sole
assessment date,current year assessment date,current year date ofgen, legal o```���+++unable owner?(3 goo Yes ❑ No
If no.what is his 1 her exact share of interest? If owned with sorneornher han souse.indicate with whom
If name on record is different than that of appeant,indicate below. property in question:Annually Assessed
Real Property 0 Annually Assessed
ft ble Home(IC 6-1.1-7)
Name of I or seller FILED
Address ofof mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage 13
AUG 4-t2019
Address of assignee(number and street,city,state,and ZIP code) - -
n ��
Does applicant own property in any If yes,what county? What Taxing District? - '•fii:'`ii1,;:•)v -n requested If yes.state amount of deduction
inndiaana7?ty ❑Yes ❑No GIBS 'NT,.044fi fY3OIToo
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 rredit 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 0 20 20 • 20 ' 20' 20
Signature of CountyA County % Date(month, y a
II We certify unde e penalty of perjury ve and foregoing information is hand coned and that the applicant' a rs ent of Indiana and
owner 1 contract buyer of the aforementioned property on date application is filed.
Signature full na / Dab ,,day, ar1
. 0.ad s f1,02/Jber/�d�t�et. ty,safe,and LP code), r) (1-�l ("�1
Ft Ir( iode fYl-.o` `` t f 11l'Yl • ^` Jt
Person authorized by 4Idf'executed Power of Attorney or by IC 8--1.1-12-0.7 Date(mot day,Ta61
Address of authorized person (number and street city,state,and ZIP code) ,N1 11
The penalties for perjury can include imprisonment up to Iwo and a half years and a fine not to exceed S10,000.