HomeMy WebLinkAboutMortgage_Koch (4) h STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
n A FOR DEDUCTION FROM ASSESSED VALUATION
• -f` State Form 43709(R13/10-15) \Cj'o 1/\ ��\q
R° „,,-# Prescribed by Department of Local Government Finance \'
INSTRUCTIONS: (`)
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.
Appli t(ownerorct ba r- rests bns on reveid
ikZe` ' .
Tig Disti K mber/'sal descriptio
-`� Recw tJm`et\ P„eJVe_` lOO - Il-\\"-. OI � _oG
Assessed value property s of Mortgage ontract indebtedness unpaid as of Mortgage!Contract indebtednesqugpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date a I" tip1A �^�/,'� O LAJ legal o e able owner?
L lc
JrlJ1 Yes ❑ No
If no.what is hist her exact share of interest? I �; with s m e othelthan spouse,indicate with whom
If name on record is differentthan that of applicant,indicate below. I e property in question:Annually Assessed
Real Property ❑ Annually Assessed
ITC C 0 5 2019 Mobile Home(IC i-1.1-7)
Name of mortgagee or contract seller E_Tvtut
..
Address of mortgagee or contract seller(number and street,city,state,
GIBSON COUNTY AUDITOR
Name of assignee or other owner or holder of mortgageDrawer NO
.o,o (
Address of assignee(number and street,city,state,and ZiP code)
Card NO.
Does applicant own property in any If yes,what county? What Taxing District? Has this deduct ........
other county on property for _
in Indiana? ❑Yes 0 No current year? __
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 me cvu„ty
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 1 , 20 20 20 • 20 ' 20' 20
•
Signature of Co i iltor County Date( ntl,Aayqd
I/We certify P der the penalty of perjury that the above and foregoing information is true and correct and that the applicant s a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's fullaname n Datemon ,d
ull r dent address of applicant(number and street,city,state,and ZIP code)
8 v3 S(L\6s O'vi\lc -3n_ "►9-
Person authorized by duly executed Power 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 year's and a fine not to exceed$10,000.