HomeMy WebLinkAboutMortgage_Pegram (8) ,--,.c4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
4A FOR DEDUCTION FROM ASSESSED VALUATION
:1 • State Form 43709(R13/10-15) GIBBON
° -�° 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 m he calendar year for which the deduction is sought.
Must be filed or postmarked with the County 1 u itor or County Recorder of the county where the property is , County Auditor
located on or before January 5 of the immediately succeeding calendar year. - 'L11 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.
Applicaryt(owner or cont c uyer-se trictions/oonn reverse side)
eljtTaxing Disp 'ct Key nu er/le al description (--)1U � _— Record number Page number
26 r l -Zu-202--- p01 — 2� �� 2
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 f Maticrbo 1(� legal or eq • ble owner?
� Yes El No
If no,what is his/her exact share of interest? If owned wit someondother than spouse,indicate with whom.
If name on record is different than that of applicant,indicate below: Is property in question:Annually Assessed
Real Property ❑ Annually Assessed :,
`` \\ Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller -
4
Address of mortgagee or co*trac le(n.'i—• )'and streetT. ,city,state,and ZIP code) r T Drawer NO...2rn,. . ..
Name of assignee th ?per, olderoff n tgage /
T)-0 g
Address of assignee umberanndrstreat,city,state,an IPcoode)e) Card NO,
Does applicant own property in any If yes ki/59 What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county -, t" on property for
in Indiana? ❑Yes ❑N ��� current year? ❑Yes ❑No
A person is not entitled to this d o unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including els e 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 .q
/ 20 20 20 20 20 lit
Signature of County Auditor County \jc.s .\ Date(m th, y, ar)
I/We certify under the penalty of perjury that the a oing information is true an c rrect and that the applicant is a esident of Indiana and
owner/contract buyer of the aforementioned prop y on date application is filed.
Signature ner's full nam ) Date(m a y
/�'�� ?!,-
ull rgdgnt s of applican�{n nber ancreet„Pity t nd ZIP code)f^ /4 q '
5`�((JJ,� rW� �oJ 11 /� 111 K/J o
Person authorized by duly executed Power of Att6rney 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)