HomeMy WebLinkAboutMortgage_Root 0. n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
_;� FOR DEDUCTION FROM ASSESSED VALUATION p_Tu.sv
&L)0< -'%` f' State Form 43709(R13/10-15) , \1/� `.' ;, .' Prescribed by Department of Local Government FinanceJ`
INSTRUCTIONS: File Mark
To be filed in person or by mail. Fo filed with:
Filing Dates: 1) Real Properly: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 it County Auditor
located on or before January 5 of the immediately succeeding calendar year. raI.County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the pnope is located during the twelve(12)months before March 31 of each year the deduction is sought .
See revs"'''- de for additional in tructions and quaff 'ens.
Appii.- t(o er or n Ayer- strictions on reve side— •
Taxing''st' Key um r/1 gal d crip' Record number Page number
-U) —31 -200 -Ods, $1 7-O 2� , 2‘ 1 °t Ho I i
Assessed value of real property as f Mortgage/Contract indebtedness unpaid as of Mortgage/Contract inde edness unpaid as of Is the a pli.r t the sole
assessmentdate,current year assessment date,current year date of app'catjp{r �.-. as)t legal or'.•.dable owner?
U]l-�\ �o%-� I Yes ❑ No
If no,what is his/her exact share of interest? If owned with some ne other than souse,indicate with whom
/
if name on record is different than that of applicant,indicate below: I. . -property in question:Annually-ssessed
It Real Property 0 AnnuMobile ly Assome ss(IC e-1.1-7)
Name of mortg gc contract II
r} At(e l j""—'.—
Address of mo agee or contra, sel r "(number and s te,and ZIP cod
Name of assignee or other owner or holder of mortgage
FI E . .
Address of assignee(number and street,city,state,and ZIP code) iiY
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 on property for
in Indiana? ❑Yes El No , current year?.O UY+. :DE
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 offi that
for deduction.
COUNTY AUDITOR
Deduction approved in the amoun of: GIBSON COUNTY AUDITOR
I .
20 Zr 20 20 20 ' 20' 20
Signature of County Auditor County Date(month,day,year)‘s c.: } [0,0 A 1 .
I,We certify under the penal • of perjury that the ab foregoing information is true and correct and that the applicant is a resi�nt of Indiana and
owner/contract buyer f aforement ned property on date application is filed.
Signs er' fir Date(month,day,year)
e.
10/1/ZeI,
F resident a dr ss o pplica (n per and street city,stale,a ZIP code) ~
��al ►� Ae4 )(t om— x � „ - ,Y\ ki 9 ()-
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
I 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.