HomeMy WebLinkAboutMortgage_Saliju . -, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
. `'' A FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15) 6/I`�°-` ,, , Prescribed by Department of Local Government Finance3 r g I a0A.eu
File Mark
INSTRUCTIONS: . 1
To be filed in person or by mail Form filed with: `
Filing Dates: 1) Real Properly:Must be complet - • (': -•r, 71.- "en r :>. .. <ich r e deduction is sought
Must be filed or postmarked ' L e .• A .I•r Co ty -ecorder of the county where the property is County Auditor
located on or before January 5 o'r. e P ..e -1 succeeding calendar year. County Recorder
2) Mobile/Manufactured Homes not=K essed as Real Property:Must file with the County Auditor of the county
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.
Applicart(ornsfo con of bu er-see res 'ns on r e de)
m-Iii
Tap g District Key number/legal descrip'o Record number Page numb r
4-10 26-1°t-6 -obl .361 -02G. lC{ `3st
Assessed value of r property as of Mortgage/Contract indebtedness unpaid as of Mortgage I C ntract indebtedness unpaid as of Is the ap li nt the sole
assessment date, ent year assessment date,current year date of ap titolct5 ^ legator [table owner?
_OD U Yes ❑ No
If no.what is his i her exact share of interest? If owned with someon other than souse,indicate with whom
If name on record is different than that of applicant,indicate below: Is a property in question:Annually Assessed
Real Property ❑ AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortga ee contract se e1, ,
,b/�ie4 l�C FIL.
Address of mortgagee or contract seller or
and street city,state,and ZIP code)
OCT.2 5 2019'
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) 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 on property for
in Indiana? ❑Yes ❑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 r f 20__G__:sycji. 20 20 20' 20
Signature of County Auditor County Date(mono,day,ye r) 01
I/We certify under the penal • of perjury that the above and foregoing information is true and correct and that the applicant is 1l resident of Indiana and
owner/contract buyer of the aforeme 'oned property on date application is filed.
Signature r' li n e))cf
Date(month,day,year)
/D/34S,Q0f2
Full r en address of pli t(n ber and street,city,state,and ZIP code)
Person authorized by duly execut d Power of Attomey 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)
f _.• -_
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.