HomeMy WebLinkAboutMortgage_Daley fa" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
. ,;- FOR DEDUCTION FROM ASSESSED VALUATION �� 1 t� Zq�
•`1'='''):-w State Form 43709(R13/10-15) 1
S w Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
75 be filed in person or by mail Form filed with
Filing Dater 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 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 March 31 of each year the deduction is sought
See reverse side for additional instructions and quafflcations.
Appfi t,E4wner or contras bilr-see-on reverse sidee')� ,1 (�'''J r1 ecord number /�[(y
Taxirmg D'¢trid n Keyr
mrmberr leg \2,- W -000- 3-13 —`/ `— !ill `. Page
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Assessed value of real property as of 6 Mortgage/Contract indebtedness unpaid as of I Mortgage/,Conrad indebtedness unpaid as of Is the ' nt the sole
assessment date,current year assessment date,current year I date of ay¢li�a; a legal or cable owner?
Y�LV.ne of es ❑ No
If no,what is his/her exact share of interest? If owned with son ne oNe than spouse,indicate with whom /`1
If name on record is different than that of applicant,indicate below- i I Y J �I a goes o Annually Assessed
• eat Property ❑ An.
Assessed
Nbbtle Hoare(IC 6-1.1-7)
Name riortgage
\�J11 Clnh SEP 9 2019
Address of mortgagee oc contract seller(number and>beet city,state,and ZIP code) ' •
Name of assignee orother owner or holder of mortgage �l
GIBSON COUNTY AUDITOR
Address of assignee(number and sleet city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Tang District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes 0 No current year? ❑Yes 0 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 S/�20 ( I )_20
, 20 204 20
Signature a County Auditor - C t County • Dah.,,(m rap
3 (..n is a
I/We certify under the penal •-(jury that the above and foregoing information is true and correct and that the applican a ident of Indiana and
owner I contract buyer of the aforementioned property on date application is Red. h
G 5' re(ownees full name) Date( th pye
� address of a (number ely,state,m�d ZIP cdde)
X �
a\ CM — '(' `` - 3Y -`l-6 'ra
'Person authorized by duly executed Power of Attortrey or by IC 6-1.1-12-0.7 Date(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.