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HomeMy WebLinkAboutMortgage_Craig III .o, 6'4ik STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownship I/'1`\.y Year Wit,; FOR DEDUCTION FROM ASSESSED VALUATION '� State Form 43709(R13/10-15) GIBSO Prescribed by Department of Local Government Finance - Ia ' �me - File v . u • INSTRUCTIONS: To be filed in person or by mail. efO/ Form filed wi .-d"} 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' �'�p}inty Auditor located on or before January 5 of the immediately succeeding calendar year. O,p� • ❑ ``Coounty Recorder 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor tr/ where the property is located during the twelve(12)months before March 31 of each year the deduction i ids See reverse side for additional instructions and qualifications. A/rY Applicant(o r o contract see rest' ion vers 1 C/rs oI7, Z1.142.14QR. gtpg T in i rict Key nu ber/legal descri io Recor number Pa a tuber cz- Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole assessment date,current year assessment date,current year date of app I' tion' legal or equitable owner? /t0 <(p.yC, ❑ 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 a property in question:Annually Assessed Real Property ❑ ArinuallyAssessed Mobile Home(IC 6-1.1-7) / Name of mortgagee or contract seller i ,,, 2 ,,iAddress of mortgagee or contract seller(n ber and sit,city,state,and ZIP cod Name of assignee or other owner or holder o:c?=ge 4c2&J S9Aa Address of assignee(number and street,ci ,state, ZIP code) Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested I If yes,state amount of deduction other county on property for in Indiana? ❑Yes ❑No _ current year? _❑Ya_c El Kin_ __— A person is not entitled to this deduction unless the person has a balance on the orded in the county recorder's office(including any home equity line of credit that is recorded in the c )n. COUNTY A �7 Deduction approved in the amount of: Draw er N O 4,9Z d--0 20 20 20 20 gffq 20 Card NO. .. Signature of County Auditor C 'ear) I I I/We certify under the penal of perj (that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and owner contract buyer f t afore Toned property on date application is filed. Signatur o er ul!nam Date day, „ Full re ' e ddress o app a u per d at et„city,state,an I ode 6 ©( (�,rj// 0 ' .,I Person authorized by duly executed Power of Attorney or by I 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.