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44 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
- -��`� FOR DEDUCTION FROM ASSESSED VALUATION
Si " .-'t'` State Form 43709(R13/10-15) GIBSON 20'25)
° 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.
Appli - 0 eror contract buyer ee ctions on reverse side) d
D Gc� S, Q ma7
( �T g of Key number/legs n Record number Pa num er
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Assessed value of real pro of Mortgage/Contract indebtedness unpaid as of Mortgag Contract indebtedness unpaid as of Is the applicant the sole _
assessment date,c Trent y 1� assessment date,Current•year to of pl%ILI rn0 legal or equitable owner?
/y V 0 Yes ❑ No -
If no,what is his!her exact share of interest? if owned with so eons other an spouse;indicate with whom
If name on record is different than that of applicant,indicate below: Is th property in question:Annually Assessed
Real Property 0 Arinually-Assessed
Mobile Home(IC 6-1.1-7)
�me of mortgagee or contract seller •
c�i Yl O cas h S ,i , li .
Address mortgagee or contract seller(numb4vi)2 nd
, Ail-
4 '
street,dty,state,and ZIP code)ICJS ) Wot .� ��( �e of f 4 ZZ , , i
Name of assignee or o -r,aPerorho r of mortga , n a �ryY R "0
if / f o J 'U[� /.� �520?
Address of assignee umb-Q d street dty,state,and ZIP code) G/e
Does applicant own property In any If yes,what county? What Taxing District? Has this deduction been req esstted L' o eduction
other county - on property for TY
in Indiana? ❑Yes ❑No current year? ❑Yes ❑No '9(/o
" A person is not entitled to this deduction unless the person has a balance on the person's mortgage.or contract indebtedness that is recoe9/?the county
recorder's office(including any home equity line of credit 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 ty Auditor County Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed,
is
Signab4 Lowners it na ) Date,(npnth,c(�y, ea
• a,J/
Full resident addre of placant(number and street,city,state,and RP.c.ode)
I19zO S, Whisper/ 4 Ikls rd.
Oadc. land C1`y /N ‘174
Person authorized by duly executed Power of Attofriey 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 S10,000.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT iND `'•�1LV
E i
Na ej.licant Name of mortgagee or contract sell,?v S. d `Gum .(Z/Z4li
Date filed(month,day,year) unt of indebtedness T Dis�' /
,n/ /
KQeteegarddo=/ / o3 / V /OfOV6
Signature ofAuditor./Co Re er County GIBS° a year)
GiBSON iN 0 Y A rr ""