HomeMy WebLinkAboutMortgage_Noe STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES Cpunty o nship Year
f = FOR DEDUCTION FROM ASSESSED VALUATION 4
State Form 43709(R13/10-15)
'' ,e„i' Prescribed by Department of Local Government
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Must be filed or postmarked with the County Auditor or County Recorder of the county whe - hi,. -1•: q1�F �rr ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. um I r 111 County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the CouPPlaci I(fgYg1 'f}P
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. Xai
Appiignt(ownerorcontractbuyer-see strictions sides_,I `f`,
Taxing rs 'ct , Key number/legal description Record number Page number
a2-,i _/,3 - ,za </ o3. / g9-ors AOI9 51o <'
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,cun'entyear assessment date,current year date of application legal or equitable owner?
4 -7 5oa El Yes El No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
if name on record is differentthan that of applicant,indicate below: Is 9e property in question:Annually Assessed
Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller U
Address of mortgagee or contract seller(number and street city,state,and ZIP code) O r Q
Drawer NO...a) L rf _
Name of assignee or other owner or holder of mortgage
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 deduction I
other county on property for
in Indiana? ❑Yes El No current year? C
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.
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20 20 20 20 • 20 ' 20' 20
Signal ture,of County Auditor 'r 7 County • Date(month,day,year)
II//We certifyeunder na! of a'u that the above and re going information is true and correct and that the applicant is a resident of Indiana and
penalty perjury ry 9 � 9� PP
owner/contract buyer of the aforementioned property on date application is filed.
6. Signature(o ne full na on Date(month,day,year)
Full resident address of applicant(number and street,city,state and ZIP code)
eO7 Mq(e reso, Ave viev/ofr / t 4/-717
Person authorized by duly executed Power 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 yeats and a fine not to exceed$10,000.
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RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRAC 'ND T DNE
Name of applicant Name("lhortoaaee nr rnntra selie
` 4-c, cil A/4,1444-) 6-6 -j 42e4at ;rit e 2019
Date file (month,day,year) Amount of indebtedness Taxin ' c
Key umber/legal description '
;('O _(j —(3 ,- xo y- too 3 . i8 !Q - oxf r
GIBSON CQQUNTY AUDITOR
Signature of County Auditor/Coun Recorder County 1 Date(month,day,year)
zdAteA/41.4- 7,e,- _