HomeMy WebLinkAboutMortgage_Brown (9) • STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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, ��r FOR DEDUCTION FROM ASSESSED VALUATION 4 �r1 �2r^ �r
•' Imo' State Form 43709(R13/10-15) 9Y' l V i
!' °ia Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by maiL F led 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.
licant owner or ntract buyer-see restrictions on reverse side)
rJD ,,-.1
Taxing 'ram Key number/legal description R d number Pa nup�he
.F.- J 2 6 78=ZVI-?�2-000 .�t13--c:72_� ° l7
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgag I Contract indebtedness unpaid of Is the ap licant the sole
assessmentdate,current year assessment date,current year date pplicatio legal or, q 'table owner?�
Yes 0 No
If no,what is his/her exact share of interest? If owned with,s eone other thankpouse,indicate with whom
if name on record is differentthan that of applicant,indicate below: Is property in question:Annually Assessed
eal Property 0 AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of ptgagN or ckntract seller -- — 1 ___., ED ..
Address of mortgagee or contract seller(number and strei ; O/ 9 — O 6-6 (' -
Name of assignee or other owner or holder of mortgage Drawer NO.. J/1N 0 2020
Address of assignee(number and street;city,state,and i ; . 4...coatr-
Card NO.
..................... GIPSON e(((111UNTY AUDITOR
Does
her county nt own property in any If yes,what county? What Taxing District? 1 on property for requested I If yes,state amount of deduction
otin Indiana? ❑Yes El NO I current year? Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or n_ ct 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)tha 's the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 •20 • 20 ' 20' 20
Signature of County l it., vel County . \ ,,,-."-\ Date(month,day,year)
i.
I,We certify under the penalty of perjury that the above and foregoing infomtation is true nd correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
X Signe owner's re) - Dat�(m nth,day,year)
b ' Z/h��
Full r iden drg5s of applicant(numberand~--
city, and ZIP code)
Person authorized by duly executed Power of Attorney or by IC 0-1.1-12.0.7 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.-