HomeMy WebLinkAboutMortgage_Garrison (3) ��...,ec STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownshipYear
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�; , �� , FOR DEDUCTION FROM ASSESSED VALUATION �
�' 1.,...,:.,, State Form 43709(R13/10-15) GIBSON 1, l W� ao
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,es Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
To be filed in person or by mail.
❑ 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 re rs side for additi nal instructions and qualifications.
Applicant nelerr or co tract burge rest`c/tigns on reverse de) �y�/,� �•,�,�
V U+nllfJ�� fILpJ,I\ la � r1JV
Tax g District Ke n tuber/legal descrip on Record number Page number �_
y-`V L b \2 103^�02 . —02� .20 0>�.�
Assessed value of re property as of Mortgage/Contract indebtedness unpaid as of Mortg e/Contract indebtedne id as of Is the plicant the sole
assessment date,current year assessment date,current year date ofl ipaSjon000 legal or uitable owner?
, Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: s e property in question:Annually Assessed
Real Property ❑ Annually Assessed
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Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 06#1,6—
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Address of mortgagee or contract seller(number and street,city,state,and ZIP co Cc&\..krjkzy.,
i
F/LE
Name of assignee or other owner or holder of mortgage sc
Address of assignee(number and street,city,state,and ZIP code) MAR 17 2020
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested I yes,s-te amount of deduction
other county on property for /
in Indiana? Yes No current year? y\Yribt 4►:;t�.,El011
p.
A person is not entitled to this deduction unless the person has a balance on the person's mortmp,q 1s(rinc(-. •,n s a i, corded in the county
recorder's office(including any home equity fine of credit that is recorded in the county recorder'Stfriderthat is We basis fcir the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20
Signature of County Auditor ���j ' County Date(3nth,dlr, a /'1 2 o
I/We certify under the pe of perjury that the e and foregoing information is true and correct and that the applicant is resident f Indiana and
owner/contrac buyer of th orementioned property on date application is filed.
gn eiw// me) Date(mh,hylal
7D
Fu !Anti;dress applica t(number and street, tat and ZIP code)•
•
Person authorized by executed Power of Attorney or 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 perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.