HomeMy WebLinkAboutMortgage_Edgington �E— STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
l—%ma's FOR DEDUCTION FROM ASSESSED VALUATION -
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"\ _, State Form 43709(R13/10-15) --- _ _ GIBSON ,+/
* a • Prescribed by Department of `"" `��2��
INSTRUCTIONS: • File Mark
To be filed in person or by mail. Drawer PTO,,,( dd6 Form filed with:
Filing Dates: 1) Real Property:Must be col ''' ''''' on is sought.
County Auditor
Must be filed orpostmarke where the property is tY
located on or before Janus Card 1, �r o• 3 3Q 1 County Recorder
2) Mobile/Manufactured Hor y Auditor of the county .
where the property is locatt.___..._„.. tr the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(o ner or contract buyer-see rest fictions on reverse side)
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Taxi Di t Key
indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal o e uitable owner?
4/6 WO Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the operty in question:Annually Assessed
ICI Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of ortgagee or contract seller -
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Address of mortgagee or contract seller(number and street,city,state,and ZIP code 1 V
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Name of assignee or other owner or holder of mortgage
AUG I n2.0
Address of assignee(number and street,city,state,and ZIP code)
Does countyicant own property in any If yes,what county? What Taxing District? HaS,s:--'i?7ru '•n •:�ta�uested If yes,state amount of deduction
other ��` 1�
in Indiana?
❑Yes ❑No , &m.o. a?"t es ❑No
A person is not entitled to this deduction unless the person has a balance onQtafggr'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
Sign re o County Auditor County Date(month,day,year)
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I/ e certify under the pe alty of perjury that thee and foregoing information is true and correct and that the applicant is a resident of Indiana and
er/contract buyer he afor m ioned prokgrty on date application is filed.
.X_Signatureinee I name Date( nth,day,year)
7 202 (3
Full r= •-nt a ess of appli nt( umber and s reet city,state,and ZIP code)
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P: -on authorized by duly executed Power of Attorney 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.