HomeMy WebLinkAboutMortgage_Unversaw 1 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�_ .-`ien4. FOR DEDUCTION FROM ASSESSED VALUATION
3'1K s' .,41-�+ State Form 43709(R13/10-15) GIBSON fl * �f('�O\'�{—''J Prescribed by Department of Local Government Finance t�+c.
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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 owner or contra buy* Scu
restrictions on reverse side)
Taking Dist•ct umber/legal description Re nu b WJL
-V),-v8i os-o dl .t-Ii2-vr2-E .
Assesse value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebte_dDess unpaid as of Is the a plicant the sole
assessment date,current year assessment date,current year dat f p lication fV legal or ble owner?
goo- Yes ❑ No
If no,what is his/her exact share of interest? • If owned wit some other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: t. property in question:Annually Assessed
It Real Property ❑ Annually Assessed
E
k� Mobile Home(IC 6-1.1-7)
Name o mortgagee contract seller
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Address If mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage �Af� gin
Address of assignee(number and street,city,state,and ZIP code) fli Sin //
R
Does applicant own prope in a y If yes,what county? i If yes,state amount of deduction
other county
in Indiana? ❑Yes o 3
A person is not entitled t this eduction unless the pers A.,pevaiLii
dness that is recorded in the county
recorder's office(including any'home equity line of credi s for the deduction.
Deduction approved in the amount of: t r Cr S
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20 0 1v�\` ?0 20
Signature of County Au 'o 1c7A
^ 1_48,-
Date( t �1ay, r)
::
I/We certify unde he penalty of perjury that the abc iplicant is resi ent of Indiana and
owner/contract buyer of the aforementioned propert
Signature(o /s fulfulname) �� i l W1-1
Date( th `a, ea �
".IX
FullA twaddddress of appliica/nt(numb nd street,city,s tC r
Person authorized bex'c`ed�Power of Atto ey or b IC I l� 1 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
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