HomeMy WebLinkAboutMortgage_Brown �En,!,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
'� State Form 43709(R13/10-15) GIBBON
•y,;, < 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.
Applicant(o ror co tract b yp.zi see restrictions on rqVwe side)
Off(Owirlek YNown
xmg District 111 Key number/egal description ord number Page umber
-Tu.) s f • 26 -- 12Z-oG-71 -003. S�16 - p23- . 02Q 1 Assessed value ofal property as of Mortgage/Contract indebtedness unpaid as of Mortgage Contract indebtedness unpaid as of Is the pli nt the sole
assessment date,current year assessment date,current year date of plica n legal o noble owner?
1 q r 00 0---- Yes ❑ No
If no,what is his/her exact share of interest? • If owned with so eon ther than a¢o sse,indicate with whom
If name on record is different than that of applicant,indicate below: I't the property in question:Annually Assessed
11 -=.P ..erty ❑ Annually Assessed
, PI I zt- Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller �I _f_ 4
��/ Q 1'/l r'l./A�— r-0 �, Q
Address of mortgagee or contract sel-'t mber and street,city,state,and ZIP code)
JUN 9 2�2�
� VVV
Name of as: �.)
•
Address of :56
i0/0 /a- GfesoN `QUIVT
/�/ /� , AUDITOR
•
Does applies dO—// /1, 6 )istrict? Has this deduction been requested If yes,state amount of deduction
other county ((// / on property for
in Indiana? current year? ❑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 0 20 \ 20 20 20 20
Signature of County Au ' i ` County \�v„ Date( n y)i�•
I/We certify under a penalty of perjury that t e a ove and foregoing information is tru nd correct and that the applicant is resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
yignatu wners f me) Date o ttj,dr year)
Fyl>,re7ddre$s of appli�t(� r an s�e'Jt ci st and Z)IPTdr-bH1
Person authorized by duly executed Power of Attorney or bd
) C 6-11111.1-?2-0.7 `_J\ 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. •