HomeMy WebLinkAboutMortgage_Sisson (2) .McrrE STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESSTownship
i�� CountyYear
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` > State Form 43709(R13/10-15) GIBSON V `` 0
�• • •Prescribed by Department of Local Government Finance V �J
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INSTRUCTIONS: C.
7IY-'` LO File Mark
To be filed in person or by mail. l� Fo filed with:
FilingDates: Real Property:Must be com lefed
1) p and dated in the I ndar 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 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. '
Appl` t(owner or cont c yer-s e r'at'ctions on reverse side)
1 �0�1� � '3 SC SS\Df`
District K mber descriptio Record number Page number
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 application . '` ' legal o quitable owner?
Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom /// 1-
If name on recc t 0 05--O — / 1 /' - Is h property in question:Annually Assessed
(P • eal Property ❑ AnnuallyAssessed ,
✓✓✓ ��1 Mobile Home(IC 6-1.1-7)
Name of mortg
Drawer NO
• e
•
Address of mo CarL1l, NO. ILE•
•,:;
. .
Name of assig .. .. - y
JUL 1'5'2020
Address of assignee(number and street,city,state,and ZIP code)
ji •
Does applicant own properly in any If yes,what county? What Taxing District? �jq this ; ted . If yes,state amount of deduction
other county 4 lf� LE NT( � ' '
in Indiana? ❑Yes ❑No current year? L7 S T
A person is not entitled to this deduction unless the person,has a balance on the person's mortgage or contract indebtedness that ts,recorded in the county.
recorder's office(including'eny home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction..`
COUNTYAUDITOR .., ,
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County d'o County Date(inonth,da,yea
I I We certify under t e penalty of perjury that the above and foregoing informationrue and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
xSignature(owner's full name) Date(month,day,year)
� - -7• Is'- �� .
-FpII resident address pLappli tsqummbber and street,city,state,and ZIP code) K- �_
S ct I l J \\e�- Y1 - y Z
Person authorized by duly executed Power of Plttorney 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) .
I
The penalties for perjury can include imprisonment uo to two and a half years and a fine not to exceed S10.000.