HomeMy WebLinkAboutMortgage_Claflin STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
ter; . FOR DEDUCTION FROM ASSESSED VALUATION
- '.f State Form 43709(R13/10-15)
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'4 `.m; d Prescribed by Department of Local Government FinanceF II1. E1
INSTRUCTIONS: ark
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 soupy 2019
Must be filed or postmarked with the County Auditor or County Recorder of the county where the". •pei ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. ilCounty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor o 'ae couni ,i
where the property is located during the twelve(12)months before March 31 of each year the d-•.Z':, '•r.Jyp.,Pt _,
See reverse side for additional instructions and qualifications. G I B S O N COUNTY AUDITOR
Applicant(owner or contract buyer- restrictions onreverseside) l
Taddpg District , Key number/legal description Record number Page number
(/�lll c2.6 - 65-617 -09y - DDD . 5"/4,� 0/ 7 0149/9 Li4e8
Assessed value of r property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date, nt year assessment date,current year date of a lication legal or equitable owner?
A / a 5 ❑ Yes 0 No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
,Real Property ❑ AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contra..seller c ^ _ 6 --
Address of mortgagee or con u,,ct seller(numb and street city,state,and ZIP ode) - - -- -
Name of assignee or other owner or holder of mortgage 02-0/ % — 4' F
Address of assignee(number and street city,state,and ZIP code)
�,lc_r N1 rf 1/6, / _
Does applicant own property in any If yes,what county? What Taxing District? Has tl
other county on pri
in Indiana? El Yes ❑No currre
A person is not entitled to this deduction unless the person has a balance on the person's mod ' "`� 1
recorder's office(including any home equity line of credit that is recorded in the county record
COUNTY AUDITOR ( / /C //...F/i nJ ^ 4 tP LrN kJ
Deduction approved in the amount of:
20 20 20 20 J
A i" l Y° G
Signature of County Auditor County - �i q / /�-S iLD
e t ; cam-_l �,� ,�
I/We certify under the penalty of perjury that the aboCe and foregoing information is trueana wna..—....-___-- -, °r — d
owner/contract buyer of the aforementioned property on date application is filed. - --
Si nature(owner's full name) Date(month,day,year)
ull resident address of applicant(number and street,city,state,and ZIP code)
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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 years and a fine not to exceed S10.000.