HomeMy WebLinkAboutMortgage_Hollis (2) 0,74, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
4 ,,r ` FOR DEDUCTION FROM ASSESSED VALUATION
a j; State Form 43709(R13/10-15) ii 1 - -`� �,,{-, 1i
`. '` d Prescribed by Department of Local Government Finance t ) 4'+"U"N ' l .
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INSTRUCTIONS: File Mark
To be filed in person or by mail I 'Fo filed 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 March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictlons'o reverse side) `
J(9(111 r �01\Is ' S r`c1kr' t 1
Taxing District Key number/I�gal des c lion Record number PT number
2G— 203 Coo\• S — 02-C. 201
Assessed value of real property as of ltdrtgage i Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the appicant the sole
assessment date,current year assessment date,current year date of-pplic tirgn 1 00 legal or ' ble owner?
es 0 No
If no,what is his 1 her exact share of interest? i t own • '164e either than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: I e property in question:Annually Assessed
Real Property ❑ Annually Assessed
N O V 12 2019 Mobile Home(IC 6-1.1 7)
Name Mgee or contr,c.1seller `
•
Address of mortgagee or contract selleA:3
er and street city,sta�e,,and code) QJti. !i'I c
GIBSON COUNTY AUDITOR
Name of assignee or other owner or holder of mortgage Drawer1trO.,'kt�,.....Address of assignee(numbCard NO
er and street,city,state,and ZIP code)
. ......3s-goi
•• .....
Does applicant own property in any If yes,what county? What Taxing District? fount of deduction
other county
in Indiana? ❑Yes ❑No i
A person is not entitled to this deduction unless the person has a balance on the pers,,,a„.v„----,,. __..__ iorded 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: I
20 20g 20 20 20 ' 20' 20
Signature of County Auditor County Date(month day,ye
INA.
1/We certify under the penalty of perjury;that the above and foregoing information is e and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
` Signatur/(o ,er's full name] Date( onth,da teals
JIV�1 K., 1 l 1 Z L i
Full rfident address of applicant(number and street,c' state,and ZIP code)
Person authorized by duly executed Powct of Attorney 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.