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HomeMy WebLinkAboutMortgage_Gabbard (3) �..-.4. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESSCountyTownship e/--.,, Year y FOR-DEDUCTION FROM ASSESSED VALUATION .\- - �• State Form 43709(R13/10-15) GIBBON O 2 2O ��---i' Prescribed by Department of Local Govemme „we File Mark /NSTRUCTIONS: To be filed in person or by mail. Form fil d with: Filing Dates: 1) Real Property:Must be completed and date. - 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 of the imrirediately succeeding calendar yea'r. ❑ ourity 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 ` tract buyer-ss e rest� ctionns o reverse side) T IM / \\OJn)e. �s�D IPA'✓6 Taxing District Ke umber/legal description Record number Page number © ZS Zb -12 --Ny 3`O2 _0uz. 2t0'A702,8 .2o2U 3)40 ,. _ Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appl- ant the sole assessment date,current year assessment date,current year ' date of ' li action ±(v\- legal b e uitable owner? Yes ❑ No If no,what is his/her exact share of interest? If owned with som- ne other than spouse,indicate with whom • If name on record is different than that of applicant,indicate below: Is t property in question:Annually Assessed Real Property ❑ Annually Assessed :. Mobile Home(IC 6-1.1-7) Name of mortgagee or contract �( seller li r r L-A . Address of mortgagee or contract seller(number and street,city,state,and ZIP code) �� ///�(��//,,,,,''/l Name of assignee or other owner or holder of mortgage IF'I Drawer 1\O....5-!':',�� Address of assignee(number and street,city,state,and ZIP code) J U L 2 8 20 c Card N O. J i�° Does applicanfown property in any If yes,what county? What Taxing District? Has'thi=ded 1 other county El on` in Indiana? ❑Yes ❑Yes ❑No A person is not entitled to this deduction unless_the.person:has a balance c I t aYe/WcidlhlrfilRndebtedness that.is recorded in the county recorder's office(including anyhome equity of credit that is recorded in the county recorder's ofice)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 - County Date(month,day,year) • • I I We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and owner/contract buyer of •- aforementioned property on date application is filed. Si ull n) may-. v (---(//--N jr Date(month,day,year) ull residegt a..ress of a plicant(number and eet,city,state, qd ZIP code) IC '(11 CMn \� Y1 Dsn- 5 - C{r) b 1O. Person authorized by duly executed Power of Attorney.dr 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. •