HomeMy WebLinkAboutMortgage_Peach (4) ,E�,�, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
p' `'- ' FOR DEDUCTION FROM ASSESSED VALUATION
t'`,':��� State Form 43709(R13/10-15) GIBBON
�'' =%�' Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
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 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.
Applicant(o netbuyerrictipns on reverse side)
VI 11
Taxiirt' Key number/legal descrip ion Record num er Page numb
A . 2G-12�1- 0k-dd1 .4l3 -02,3 20I2- S6SI
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgag /Contract indebtedness unpaid as tl Is the applicant the sole
assessment date,current year assessment date,current year date pljpalioij R G" LAd legal or ble owner?
•!/L Yes ❑ No
e
If no,what is his/her exact share of interest? If owned with s eone other than ouse,indicate with whom
If name on record is different than that of applicant,indicate below: I t property in question:Annually Assessed
Real Property El Mobilelly Assessed
Home(IC 6-1.1-7)
Name gagee or c t se ler
(� likim'' — --
Address of mortgagee or contract seller(number and street,city,state and ZIP code) rawer NO gD
Name of assignee or other owner or holt:-.f rt.•ge
Card NO.
Address of assignee(number and street,city,state,and ZIP coc4q).O
• MAR 9 LU i o/ _ - 563 /
Does applicant own property in any If yes,what county? What axing District? f yes,state amount of deduction
other county
in Indiana? ❑Yes ❑No 1 uuuem year! LI Yes LI No I
A person is not entitled to this deduction u k.p i huolt bbe on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any hors sit iitii b it'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 20
Signature of Coun ditor, ^ County DateSoA . 2.zdey n�-\mil •
I/We certify under the penalty• •er)ury that the above and foregoing information is true and correct and that the applicant is.a re4jdent of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature owner's full name) Date Snt 4a,W2_0
Full r ident address of a licant number and street ci state a I code
bra q '-SN'ntl � �Yl- �1
Person authorized by duly executed Power of Attorney or by IC-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
The nenaltie-c for neriury ran include imnricnnmant on to two and a half vearc and a fine not In exceed gin n00-