HomeMy WebLinkAboutMortgage_Kolhouse (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
. FOR DEDUCTION FROM ASSESSED VALUATION
t`I State Form 43709(R13/10-15) 1 `0 1�
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°' , ` Prescribed by Department of Local Government Finance iu
File Mark
INSTRUCTIONS:
To be filed in person or by mail. rm led 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 CountyAuditor or County Recorder of the county where the property is County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑' ounty 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 ntra b r-see restrictions on vein de)
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Tap District mber l legal description Record numbe Page number
6 1� 2L-1 -202 000. sv°1-O26 20 c?9
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value of property as of Mortgage/Contract indebtednessi unpaid as of Mortg ge/Contract indebt ners un s of Is the applicant the sole •
assessment date,current year assessment date,current year date appi La'JJJJJJ 0 . • legal or equitable owner?
• 0 Yes ❑ No
If no,what is his I her exact share of interest? If owned with meone other/hen spouse,indicate with whom
If name on record is differentthan that of applicant,indicate below: j Lif 4'
l• 'e'4 operty in question:Annually Assessed
1 R;):-I Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
•
Name of mortgagee JAN 0 2 2020
Address of mortgagee or contr ct seller(number and street,city,state,and ZIP code)
am:cvga-----
Name of assignee or other owner or holder of mortgage
GIBSON COUNTY AUDITOR
Address of assignee(number a 1
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Does applicant own property in Drawer N O v O Has this deduction been requested If yes,state amount of deduction
other countyon property for
in Indiana? ❑Yes ❑ current year? ❑Yes ❑No
A person is not entitled to fh • �� • ►'s mortgage or contract indebtedness that is recorded in the county
recorder's office(including s Card NO. recorder's office)that is the basis for the deduction.
DR
Deduction approved in the amount of
2r f 20 20 20 • 20 ' 20' 20
Signatun-`., ounty Audit
County •` Date(mon h,day,ye r) -.
\ JC0`'/ 1
01
I/We certify under the penalty that the above and foregoing information is and correct and that the applicant i a reside t of Indiana and
owner 1 contract buyer of the aforementioned property on date application is filed.
RI
e( er's ul %me) Date(mon day,yea
253
ddenntj.dress o lipn i tan` city,Ctand ZIPrjr ci I 3c).
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Person authonted by duly executed Power of A m or by IC 6A1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code) .
The penalties forneriury can include imprisonment unto two and a half vear`s and a fine not to exceed$10.000.