HomeMy WebLinkAboutMortgage_Skelton (2) :47►. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
' - ;; FOR DEDUCTION FROM ASSESSED VALUATION
'._ State Form 43709(R13/10-15)
\s0'/N _ R•\,,,)s 20�
° ;; w' Prescribed by Department of Local Government Finance Q
INSTRUCTIONS:
File Mark
To be filed in person or by maiL Form filed with:
Filing Dates: 1) Real Properly:Must be completed and dated in the calendar year for which the deduction is sought
Must be filed orpostmarked with the County Auditor or CountyRecorder of the countyproperty KCoun Auditor
ty where theis tY
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.
Appii owner or tract buys s icBons on reverse side)
Taxing District Key number/!Kiel description Record number Page number
p \w s 4-1a-0S moo--a 01- 3 s s - o2- - '2020 fig,
Assessed value of r property as of Mortgage/Contract indebtedness unpaid as of Mo age i Contract indebtedness unpaid as of Is the applica t the sole
assessment date,current year assessment date,current year d ,f ap�hrtion �k.1
^ legal or q ' ble owner?
a\`�1l 1�.J1- Yes ❑ No
If no,what is his/her exact share of interest? If owned someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is roperty in question:Annually Assessed
Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of or contract sel(erc.—`,� _er svA
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
DraIYel NO.... .. .
Name of assignee or other owner or holder of mortgage ..��
Card NO. .
Address of assignee(number and street,city,state,and ZiP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this dE it of deduction
other county on properti
in Indiana? ❑Yes ❑No current yel
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract inaepreuness uiar is recnrued in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of.
•
20 20 20 20 ' 20• 20
0
Signature of County Auditor County \ Date(month,day,year)
vulk
I/We certify under the penalty of perjury that the above and foregoing info o i and u. , •it at the applicant is a resident of Indiana and
• , • I contract buyer of the aforementioned property on date application is filed.
S'.nature •wner's full nam•) Date o day ar)
%� FEB 2 5.2Q2n � 202�
Fullresident vl dress of-p.l•- (number and street,city,state,and ZIP code)
GN � U�'1J L_a1,v`'r_`
Person authorized`y duly executed Fowl of Attorney or by IC 6-1.1-12-0.7 GIBS O N COUNTY Date(month,day,year)
AUDITOR
Address of authorized person (number and street,city,state,and ZIP code)
The penalties foroeriury can include imprisonment uo to two and a half years and a fine not to exceed S10.000_