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g . ,„,, STATEMENT OF MORTG re. t3 N-,-A TBE !GS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
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• : �' State Form 43709(R13/10-15) GIBSON Ge
ta,a Prescribed by Department of Local Government Finance •
INSTRUCTIONS: File Mark
To be filed in person or by mail. Form 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 restrictions on reverse side)
Julie Lytle
Taxing District Key number!legal description Record number Page number
Center 26-13-21-400-000.331-004 .20 5(2_.,
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,current year assessment date,current year date of application legal or equitable owner?
$50,000 ❑ Yes E I No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
Patricia D. Vanover
If name on record is different than that of applicant,indicate below: Is the propert in question:Annually Assessed
2 -e ro yty ❑ Annually Assessed
Mobile_Home(IC 6-1.1-7)
Name of mortgagee or Cact sel
Patricia D. Vanoven
Address of mortgagee or contras,..i r r,,umr,e,-.na e c.e.nd .4h....I......I........I..... -a' ' ^ ,IM- ''.. .*\\*.-‘1:— - P
Name of assignee or other own( -`� t I L y(�� ®���
Address of assignee(number ar �.( V-
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Does applicant own property in: c5' Has this deduction been rejted If yes,state amount of deduction
other county on property for pp,,Cj
in Indiana? ❑Yes ❑I current year? ❑(Y05 ❑No
A person is not entitled to this erson's mortgage or contract indebtedness that is recorded in the county
recorder's office(including ar vnty recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
i SJmL� 12-- I S-l 9
1 We certify under the penalty of perjury t t the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owne ntract buyer of the aforementioned property on date application is filed.
YSign ure ne/s II name) (month,day,year)
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Full residen dress of applicant numbe street,city,state,and ZIP code)
Person a zed 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 years and a fine not to exceed$10,000.