HomeMy WebLinkAboutMortgage_Geuss (3) ,jT'a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County , Township , Year
._.; . . FOR DEDUCTION FROM ASSESSED VALUATION
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g' t7'`.. t► State Form 43709(R14/1-20)016= V� 0T p�2
J Prescribed by Department of Local Government Finance ��
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File Mark
INSTRUCTIONS: To be filed in person or by mail. J Form `led with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. 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 an qualifications.
Applicant(. -r or contract buyer-see re nc' reverse sid
T=xi t ' Key Rec d�'ber/legal description number Page umb r
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Assessed value of real pro erty s 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 of application legal or equitable owner?
0moo ❑Yes ❑No
If no,what is his/her exact share of interest? I If owned with someone other than spouse,indicat it
If name on record is different than that o'---"- t property in qu ' Annu sera•
— /)6 Real Property ❑Annu .:
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Name of mortgagee or contract sellerge.. ��Z
6. S5 • 120?1
Address of mortgagee or contract seller(nt GIBS
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Name of assignee or other owner or holder Il.„-fiArl--On N Gf'7,!I UpfTOR
Address of assignee(number and str , tate,and code)Vg.OZ (7z..
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Does applicant own property in a 'I ye at c nty? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? El ❑No 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
ignatur f my Au itor /,d. (2 County Date(month,day,year)
I I W certify under the penalty of pe ry that the above 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.
Signature(owner' 1 name) Date(month,day,year)
Full resideaddress o appli n nu rand sties state,and code)4 /.. zZ aa. 9c -b()
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.