HomeMy WebLinkAboutMortgage_Heacock (2) 0,; . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
-7 h•: FOR DEDUCTION FROM ASSESSED VALUATION 1
t\"' ; = State Form 43709(R13/10 15) `` 0 1 \�1 �2Q
� d Prescribed by Department of Local Government Finance V \ •
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INSTRUCTIONS: File Mark
To be filed in person or by mail. Fo 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. ❑ 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(o a or ntract b r er-see r‘vbfctions on reverse ide)
Taxing Di number/legal description Record rum r Page number
a� 6 --t Lk—I �3-5 -�; 32�-0 7 2O\ 5 00
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indeltedness unpaid as of Is the applicant the sole
sc'ssment date,current year assessment date,current year date ;appliphon 00 legal or 'table owner?
Ut O tom— . Yes ❑ No
If no,what is his/her exact share of interest? If owned wi someone offer than spouse,indicate with whom
if name on record is ditferentihan that of applicant,indicate below: is.,-property in question:Annually Assessed
►! �;:_; ❑ Annually Assessed
geg "F I ., ._ Mobile Home i IG 61.1-7)
Name of mortg` a or c�o> eil�
•
Address of mortgagee or contra r��RJ`-
' 3AN102020
Name of assignee or other owr oi( i
Address of assignee(number a Drawer NO �; r ,/ 11�
GIBBON COUNTY AUDITOFZ
Does applicant own property in Card N O. 5'300 Has this deduction been requested if yes,state amount of deduction
other county on property for
in Indiana? Yes current year? ❑El Yes ❑No
A person is not entitled to thi , 's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any rrwrrb Cyrmly BIM VI ucv,t UIQL,O,GW,uvv H,Luc.LAO1....,,acorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 0 20 20 20 ' 20' 20
Signature of County Au ' r County • Date(month,day,year)
I/We certify under th penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
er I contract buyer of the aforementioned property on date application is filed.
Si to w r'.full name) Date{month,day,year)
oet,
uli id t address of applicant qru ber and treet city,state, P ode)
_ citPerson authorized by duly executed Power of Attorney or-by IC 6-1.1-12-13.7 Date(month,day,year)
1 r-t°^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.