HomeMy WebLinkAboutMortgage_Emmett „,Nei*->eq, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
° Rs FOR DEDUCTION FROM ASSESSED VALUATION
” 'tS�� State Form 43709(R14/1-20) • Di,as �ZemsPrescribed by Department of Local Government Finance 1 _1E ') 1I4
V File Mark
INSTRUCTIONS: To be filed in person or by mail. FEB 2 3 2021 Form filed 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 countyn where the property iCCC
located on or before January 5 of the calendar year in which the property taxes are� g�pe2bl�, ounty Recorder
See reverse side for additional instructions and qualifications. GIBBON COUNTY AUDITOR . •
Applicant ner or contract buyer a result' on reverse side)
Taxin i Oct Key number/legal description Record number 'Page number
d - /, _04 , Yd / - oa.1. 67,65 - aa8 v f ?.3Z
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,of application -p legal or" equit owner?
0/87 7 e es ❑No
If no,what is his/her-exact share of interest? If owned with someone othI than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
[Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contracts I r s /l
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) �C(/!�
Name of assignee or other owner or holder of mortgage -- _ - --
Address of assignee(number and street,city,state,and ZIP code) • l�V 4 / 9. .
Does applicant own property in any If yes,what county? What Taxing District? Has this del ��TT
other on property Drawer NO
in Indiana?county
III Yes III No current year
A person is not entitled to this deduction unless the person has a balance on the person's mortgage,
recorder's office(including any home equity line of credit that is recorded in the county recorder's on
COUNTY AUDITOR Card NO.
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor ',
I/We certifyCounty Date(month,day,year)
`% `/',`
the penalty of perjurya and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned pro erty on date application is filed.
Signaturetk is full na e) Date(month,day,year)
pZ/ /gal
/Full r de address o a plica t(numbera street,city,state,and ZIP de)
,( L 7 02 CCP77�v�vop ��//� /1,Cc—rr�y /f/ ''?? 7 c2
erson authorized by duly executed Power of Attorney or by l&6- 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.