HomeMy WebLinkAboutMortgage_Witte STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count uffir J Year
FOR DEDUCTION FROM ASSESSED VALUATION s -
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i 9. State Form 43709(R13/10-15) GIBSON+ I
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,,16 Prescribed by Department of Local Government Finance r
1
INSTRUCTIONS: 'i16 Nlarlo I
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 countywhere thc�p i� n Auditor.
located an or before January 5 of the immediately succeeding calendar year. •N Cp I:�+�"►•fir
2 Mobile/Manufactured Homes not assessed as Real Pro e U e ounty Recorder
p rty:.Must file with the CountyAuditorof the county A
where the property is located during the twelve(12)months before Ma h 31 of each year the deduction is sought. U
See reverse side for additional instructions and qualifications.
Applic �(ooJwneerorecoot ct buyer see rresin ions on reverse
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axin ct /7-a - Record number Page numberK� - te oa.-Oa' /73- Off/ • 20 2) Ib H- .
Asses d valu real prop as of Mortgage/Contract'indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
asse sment d ,current year 'assessment date,currentyear d of a plicaf n • legal or equitable owner?
di ODD ❑ 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: Is th roperty in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract selle
Address of mortgagee or contract seller(number and street,city,state,and ZIP c de)
Name of assignee or other owner or holde ortgage
o >°q/ C1 V Of
Address of assignee(number and st , ity, te,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county . on property
in Indiana ❑Yes ❑No currrenty year?for ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage,or contract indebtedness that is.recorded in 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,/ • my Augitor 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 buyerof the aforementioned property on date application is filed.
Signat ers fulLname):1 Dater /
ate( onth day,year)
IAA
Full resident address o applicant(number and street,city,state,and ZIP code)
`5-1"SG s. 775 kt Owe, s v, Ile, • _TA) 1-i 745
Person authorized by duly 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.
RECEI T OR FILING STATEMENT OF MORT GE OR CONTRACT INDF DYE `
N o pplicant f a e mortgage or contrac el
�! R
Date filed(month,day,year) Amount of� btedr�s Taxing D• r gat°
Key number/le al description �Off�/ff �C/
cZ-i -ate GO - . / .g- C4z/
Signature ty Auditor/Coun ecorde County GIB N a C`tda ay, r)
GIBSON OUNTYAUpI
72 4) 7v R