HomeMy WebLinkAboutMortgage_Richardson STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
s.: Co Township Year
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6 FOR DEDUCTION FROM ASSESSED VALUATION �,l r 20��
._'%• �'' State Form 43709(R13/10-15) 9bfr.
-IS Prescnbed by Deparb'rent of Local Government Finance
INSTRUCTIONS: File Mark
kJ be filed in person or by mail. For.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. ❑ unty Recorder
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
• where the property is located during the Meive(12)months before Mardi 31 of each year the deduction is sought
See reverse side foradditional instructions and qualification
nt(oxmer conffiq Ter-sv on reversesc}vis 1 _ n
y_gV,�_�n,I��l ,p1■��-- r�{),/- �JsaW�n\ ,_prt�'�Vi CJ ,\ (/�']�,.{� �7 Q Record number PPPaaaggA ��Q
gDl a� '_ \ KeY t t ti l •--Q1_ I VZ�V 1 6V V a?..r� Q \ 1 nu 4J 1
Assessed value of real property as of Mortgage 1 Contract unit edness unpaid as of M /Contact Inbbtedness unoaid.as of Is the a�{oep/I'��ant the sole
assessment dear,current year assessment date,current year da aptaciti ry/lisp Wes_ leggy l�I'Y-es 0 No
If no,what Is his/her exact share of interest? It owned vet meoneC/other/tinspormse,indicate with whom / `Y
if name on recurd is different than that of applicant,indicate below. Is •- property in question:Annually Assessed
V 'eat Property 0 Annually Assessed
• Mobile Home(IC 61.1-7)
Name of mortgagee or contract
Address ofhartga` aggee`or contract seller number and (�`,yly,st i
VU ( st eet dry sta e,a M L code)
AUG 262019
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sheet city,state,and ZIP code)
• GIBSON COUNTY AUDIT OR
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested l If yes,state amount of deduction
other county
on property for
Iddiana? Yes ID No current ear? 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 recorders office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in •amo • of
•
20 1 20 20 - 20 ' 20' 20
Signature of County Aud'. I County 1 Date(mo68L s y ar)) I ci
l We certify under - of perjury that the aboveail • aan�d foregoing information is trYeknd correct and that the applicant is a l/iddennt cif Indiana and
` f er/contra uyer of the aforementioned property on date application is filed.
re( (cr� gif ) Date( d�IGyear) itel
` 0 rend ad of a rxant nest and t , Ug9:61 L LP code) 5N r 49 C � I[J�r
Person authorized by duty executed Power otAttomey or by IC 6-1.1-12-0.7 f v Date lirep
Address of authorized person (number and street city,state.and ZIP wtle) `'�
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.