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HomeMy WebLinkAboutMortgage_Brittingham (2) .,,, z, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year . FOR-DEDUCTION FROM ASSESSED VALUATION :2_ 3 (,31'O 2 �� .e State Form 43709(R13/10-15) GIBSON 1 'Yl •'--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 V County Auditor located on or before January'S of the immediately succeeding calendaryea� 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(owner or contract bu er-see restrictions everse side) Chunk e,S S bnln�n . . Taxing ist'ct Key nu ben/legal descripti Record umber Page number l� eQ(. A-06- 16.-20o- ©d?. 4q-. 0\7- ! ?-c S d �16 Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness u a, s„pL Is the applicant the sole ' pp assessment date,current year assessment date,current year • . date of application UV legal a stable owner? 22 . Yes ❑ No If no,what is his/her exact share of interest? . . If owned with someone othe than spoyle`i-dicate with whom If name on record is different than that of applicant,indicate below: 'I t property in question:Annually Assessed Real Property ❑ AnnuallyAssessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller Reack-61.,.. � { �� c � � ' Address of mortgagee orFILED : contract seller(numberand tr et,city,state,and ZIP code) • Name of assignee or other owner or holder of mortgage . JUL 202020 Address of assignee(number and street,city,state,and ZIP code) ' Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been r 4s,i ite amount of deduction other county fo in Indiana? CI Yes CI No current year?r �Re l�I TY'AUDITOR 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 of County Auditor 1 OPCounty Date(mo h,day, _ r) 1/We certify under the penalty of perjury that the above and foregoing information is tr and correct and that the applicant is a resident of Indiana and owner/contract buyer of the aforementioned property on date application is filed. rt re(owne/s full name) f]% / Date month day,yea^r)^ ^ Full resident address ofcant( mbe ' •freet,city,state,and ZIP co e) Z1 v`> ko Person authorized by duly executed Power of Attlrney 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. RECEIP FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Name of Pelican ,) Name of mprigageq or contract self ` 17 piDate fled(month,day, ear) Am't 'of de3tc2,27 a Taxing District Key number/legal description 0w `" b,o 6 ,\ ()_?,odu 022o2 kq_ on. Signature of u Auditor/Coun ecorder County Date(month,da ear) w � 1c 1 . . , SON �- .2‘- 1oW GIBSON COUNTY AUDITOR