HomeMy WebLinkAboutMortgage_Sheehe #r am STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�% FOR DEDUCTION FROM ASSESSED VALUATION
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f ,:;.L, State Form 43709(R14/1-20)
„6 Prescribed by Department of Local Government
-f O V 0 2020 III County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where he 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.
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Applicant(Owner or contract buyer-see rest ctions on reverse side) GIBSON COUNTY AUDITOR
"trig District Key number/legal descr' lion Record number Page number
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the ap licant the sole
assessment date,current year assessment date,current year date of application legal or ui le owner?
/a S O o O es ❑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 property in question:Annually 100teal Property ❑Annually Assessed
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Name of mortgagee or contr ct seller
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) v -r1 (Q
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Name of assignee or other owner or holder of mortgage N O.
Address of assignee(number and street,city,state,and ZIP code) �T
Does applicant own property in any If yes,what county? What Taxing District? Has this c C.ar 1 O' ''' •• • •
other county on proper
in Indiana? ❑Yes No current ye. .__,•
A person is not entitled to is deduction unless the person has a balance on the person's mortgage or ont ct indebtedness that is recorded in the county
recorder's office(including any home equity fine of credit that is recorded in the county recorder's offic that s the basis for the deduction.
'COUNTY AUDITOR
Deduction approved in the amount of:
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20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
A-41..g.}i23 It:
I/We certify under the penalty of perjury that the ab and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Sign re full name) Date(month,day,year)
,Full resident address of applicant(number and street,city,state,and ZIP code)
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Person 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.