HomeMy WebLinkAboutMortgage_Bene p.7.1 SSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownshipYear
.4 ,,,: FOR DEDUCTION FROM ASSESSED VALUATION
a�'= i+� State Form 43709(R14/1-20) Gibson Ft. Branch 2020
--ii %f Prescribed by Department of Local Government Finance
IB16
File Mark
INSTRUCTIONS: To be filed in person or by mail.
Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. RI County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is
located on or before January 5 of the calendar year in which the property taxes are first due and payable. ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on
Record number Page number
Ft. Branch 26-19-19-101-000.964-026 al 6-279
Assessed value of real propert Mortgage/Contract indebtedness unpaid as of Is the applicant sole
assessment date,current year r� B date of application legal or equ' le owner?
�VI f—�(' I'l i1Q11('i 41I� �P �Y 'p1�(y� 523 ao �� Yes ❑No
If no,what is his/her exact sh Drawer NO. c QI S +t- / d with someone other than spouse,indicate with whom
If name on record is different I }, Is the. :.erty in question:Annually Assessed
Card N O. nt Y WE•` dl l open 1 Ily Assessed
�O/�oO ,/{ li obi Home(IC 6-1.1-7)
Name of mort agee or contra
Unify L9unci ,t.(.Rj joetia, (> t-T beat cu,I.
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) 0 C T 2 9 2020
Name of assignee or other owner or holder of mortgage Oteilk.CV/14
Address of assignee(number and street,city,state,and ZIP code) G I B S O N COUNTY AUTO R
Does applicant own property in an If yes,what county? What Taxing District? Has this deduction b n requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes 0 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(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
-Signs a of ounty Auditor County Date(month,day,year)
-, C 4,So)2- l0 a940av
e certify under a natty of perjury that t .ove and foregoing information is true and correct and that the applicant is a re§ident of Indiana and
owner/contract buyer of the aforementioned . ..erty on date application is filed.
Si nature(owner's full na e) Date(month,day,year)
n)( ,LIj44,, 10/29/2020
Full resident address of applicant(number and street,city,state,and ZIP code)
505 S. Lincoln Ave., Ft. Branch, IN 47648
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
10/29/2020
Address of authorized person (number and street,city,state,and ZIP code)
The nenalties for neriury can include imnrisnnment tin to two and a half years and a fine not to exceed gin nnn