HomeMy WebLinkAboutMortgage_Marsh STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESSdc CountyTownship Year
'7`- FOR DEDUCTION FROM ASSESSED VALUATION 4((( -ZIOO
--r State Form 43709(R13/10-15) 1 09.-N‘l
O� _rt t v✓-= �° Prescribed by Department of Local Government Finance v 111�e�e
I: File Mark
INSTRUCTIONS:
To be filed in person or by mail. Form 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 - County Auditor
located on or before January 5 of the immediately succeeding calendar year. I�J County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the roperty is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additi nal instructions and qualifications.
Applicant(owner or contract uyer-see restriction on reverse side)
Taxi 1?is Key number!legal description Record numbPage number
Ul � ' (.6-\— -V --i o3- u3 .601-o z01 3 003-
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage iContract indebtedness un d as of Is the a.pH., t the sole
assessment date,current year assessment date,current year date of a icatign ^/•�( legal or— table owner?
l`J r��//�(wr ' L Yes ❑ No
If no,what is his I her exact share of interest? _ If owned with son:, One other tha/I spouse,indicate with whom
if name on record is different than that of applicant,indicate below: Is a property in question:Annually Assessed
eai Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgag or contract seller (e4 _ _ k
civi‘
Address of mortgagee or contract seller(number and.t t,city,state,and ZIP code) NOVName of assignee or other owner or holder of mortgage N V 1 2 2019
Address of assignee(number and sf r.,.;' , y,te, n P.,., ~ '►
-
tt/
GIBSON COUNT AUDITO
Does applicant own prope t an, - fat,,-�•n ' `'• at Taxing District? Has this deduction been requested If yes,stare amount of deduction
other county on property for
in Indiana? El Yes CIO.•. current year? ❑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 recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20\\\\ 20 • 20 ' 20' 20
Signature of County Aud e—VII County Date(m h,da e•!11 12- -
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applican is a r ident i f Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Sign r�j(owner's fullame_) G�/ „ , _ 4„.//),.../, yr)„..41,A., Date(1 day, e
r,u resident addr s of applicant number and s et city,state, d ZIP code)
12.
,a resident
c� sN �\r-,D- �i16- .S
Person authorized by duly executed Power of Attomey-6r�r 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.