HomeMy WebLinkAboutMortgage_Inc d0'e, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
`4. FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15) GIBSON 13 S`"�.eie`" Prescribed by Department of Local Government Finance '-'�• � ,
INSTRUCTIONS: File Mark
To be filed In person or by mail. Form feed the
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. D 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.
Ap nt(owner or contryft buyer see resfrfctions reverse side)
I o1rnMeA 4. . 11 L
Taxis Dis Ke number/legal description Record n ber Page Nape.c - brlal'AL-zoo--Coo.sk?2-- lB .�)� , 1zY
Assessed value of real property as of Mortgage i Contract indebtedness unpaid es of M rtgage/Contract indebtedn u paid as of Is the pllca t the sole ;
assessment date,current year assessment date,current year e o42191)...t �_ legal or q ' ble owner? ;;
Yes ❑ No1
if no,what is his/her exact share of interest? If owned ith somethrr than spouse,Indicate with whom
If name on record Is different than that of applicant,indicate below: I t,:property In question:Annually Assessed
W Real Property 0 Annually Assessed
• r Mobile Home pC 6-1.1-7)
Name of mortgagee contract seller kflour? \
cwo
Address of mortgagee orEodfract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage F ,,,----1 ifi- ,
I D
Address of assignee(number and street,dq;state,and ZiP code) aa�� �gn�
Does applicant own property in any If yes,what county? What Taxing District? Has this d duction been reque IfiybalstZgaaunt of de• ction
other coup
in Indiana? ❑Yes 0 No • currrentt yea for ❑Yes 0 No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage• contract inde =A ness orde. r the county
f
recorder's office(including any home equity line of credit that is recorded in the county recorder's of , that is the b�I:.'+• r2tbid etton.
COUNTY AUDITOR GIBSON COUN i Y Au 7ITOR
Deduction approved In the amount of:
20 ¶)920
4320 20_ _ 20 20 20
Signature of County c County \ Da a tt a, ear)
%�1� iov) • ` 2c�,
/We certify under the penalty of perjury that the above and foregoing information is to and correct and that the appli t Is a r sldent of Indiana and
owner/cop••ct b of the aforementlo e rop rty on date app1T ation is filed.
Signature(oar -f m (e7610\a
'N1 Date m !p ly2r) to
File/Rig ad _7 of appli (n ber s et, ty, le,and ZJP,r�ade) I- 9_6 i001/4)..Svo
,
W ,Q] ,D \1 r- 4 •
on authorized by duly executed Polar of Attorney or by IC 611.1-12-0.7 ' c Date(month,day,year)
Address of authorized person (number and street dry,state,and ZIP code)
The penalties for perjury can Include imprisonment up to Iwo and a half years and a fine not to exceed$10,000.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
Name o(' cant Name ortgagee or contra el�ier��q
�, e c$ �1c . , �+��� . .
Date fee (most, yea Amount t d n Taxing District
Key b /legal d scrip•on ' ..):'"-). s C—?.)1iejl
— Oki- 6- pO. g A 01S'
Signature of County udikor County eco• r County Date( a,
S1 j, GIBSON /OW.