HomeMy WebLinkAboutMortgage_Forkel <,E��T=4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
°. �'' FOR-DEDUCTION FROM ASSESSED VALUATION
~ _ .
'r� State Form 43709(R13/10-15) GIBSON �O
- ='1, Prescribed by Department of Local Government Finance 2�
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 deduction is sought. 4County
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is Auditor
located on or before Janua& of the immediately succeeding calendaryeas ❑ 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 contr ct buyer-see res "ctions o vers side
r)`Mehf e�Q.C
Taxing District K umber/legal description Record number Page nu b
yr
, _ ,, , ,,,,, .
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Cont act.indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year ' _ date of applica n legal ore uiitable owner?
Yes ❑ No
If no,what is his/her exact share of interest? If owned with someo other than spouse,indicate with whom ' fff ,
If name on record is different than that of applicant,indicate below: I t e property in question:Annually Assessed
Real Property ❑ Annually Assessed' ,
9 Mobile Home(IC 6-1.1-7)
Namortgagee f , �/� -7��s /��� I
Address of mortgage 1� ' 'r I (- �ww
`� `'�Y L JUL 2 2 2020 •
Name of assignee o Address of assignee 4- //6 `
Tm. ,
'N COUNTY AUDITOR
Does applicant own property in any I it yes,what county? What Taxing District? " Has this deduction been requested ' If yes,state amount of deduction
other county on roe for .
in Indiana? ❑Yes ❑No 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(inclu`ding'any horrteequityYine 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 Coun u i or Countyb ..
Date(mmoo�nth,day,year) 7
Cal - •7Z' -2,o 2A
I I We certify under the penalty of pe bove and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/co4ntract buyer of afo i e roperty o date application is filed.
X Sign/�y/�er's I e) Date(month,day,year)
�`/ —7. 22. 20
Full reside ddress of apply n (number and street,city state,and ZIP code)
°G S kro ��h a—an 12—
Person authorized by duly executed Power of mttor 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.