HomeMy WebLinkAboutMortgage_Rodriguez �� „, STATEMENT OF MORTGAGE OR CONTRACT INDEBTED�/�s� � L JLCY � Township Year
_-_,1 FOR DEDUCTION FROM ASSESSED VALUATION
f,= State Form 43709(R13/10-15) « GIBSON
•
,;,=4r Prescribed by Department of Local Government Finance _
JUN 1 , 2020 File Mark
INSTRUCTIONS:
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 deductio • sough! !l
Must be filed or postmarked with the County Auditor or County Recorder of the county :;igrIr.+ 's ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. GIBSC�N COUNTY AUDITOF ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the oun y 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 instructs s and qualifications.
Applican caner or contract buyer-see rictions on reverse side)
Taxing Dis ct • Key number/leg description Record number Page number
-/ -/8 __304 - 000 . oees � oo 02od0 q9,s
Assessed value of real grope of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current yea assessment date,current year date of application legal or equitable owner?
VD., 0 0 a ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone oter than spouse,indicate with whom '
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If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
[Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortg ee or contract seller
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) ___________ _
Name of assignee or other owner or holder of mortgage Drawer NO O[U r/\�O
Address of assignee(number and street,city,state,and ZIP code) _
CISDoes applicant own property in an If yes,what county? What Taxing District? Has tl Card 1�TQ•
other incounty on
in ❑
Indiana?
Yes No current year? u 1.. .—..__
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
Signat re of County Auditor County Date(month,day,year) "
I/We certify under the penalty of perjury tha a 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.
)/ Signatu wner's fu name)* Date(month,day,year)
"r 71�t a a d.(l G J.eZ
ull residennrt address of applicant(number and street city,state,` and ZIP ode
t 7 ! t/t ( a•� l D l�`mil A NC``y 7-6 y�6F a
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.