HomeMy WebLinkAboutMortgage_Ritter (3) ,E 7,!, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownshipYear
�_.. ,
��� FOR DEDUCTION FROM ASSESSED VALUATION n /�
x,', �/. State Form 43709(R13/10-15) GIBSON V O,/1t 240/ O
Mit
4`= < Prescribed by Department of Local Government Finance
I416
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 rev a side for addition 1 instructi and alifications.
Applicant er r o t t bu r-see rest togs verse side)
irng Dis K n tuber/egal lion rd num u er P eumber
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortga e/Contract indebtedness a as of Is the applicant the sole
assessment date,current year assessment date,current year date pptc yo�y, coo/� • legal or qu' le owner?
Ut\/' �V�J1U Yes ❑ No
If no,what is his/her exact share of interest? If owned with omeone otherfhan spouse,indicate with whom
If name on record is different than that of applicant,indicate below: I e property in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ,..srai i)r
kk _____ CM i.J - Ali/ICA/1 r _O\
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
•
Name of as ��\
Drawer NO .o :1.1..-.
Address of �`1� T n MAN . 7 2020
Does appli C a r U 1\T O•• Vhat Taxing District? Has this deductio een requ ted es,state amount of deduction
other coun on property for
in Indiana% current year? A II
A person i a balance on the person's mortgittilSlabhras?lih eT s9tha9rs�recorded in the county
recorder's ;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 County Auditor County Q.l) Date'(msh, ea
I/We certify under the penalty of perjury that the above an foregoing information i t ue and correct and that the applicant is a reside of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
ignature nv's f! ame) Oa(‘i
Date o d ?Liao ��
F---*****\Sull r de ddr of applica t(numb r and eel city,state,an IP code) �-
;KM3 S S►� 6 c O,ly c- .0-4-0-‘6
Person authorized by duly executed Power of Attorney al by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
The penalties for periury can include imprisonment up to two and a half years and a fine not to exceed S10.000.