HomeMy WebLinkAboutMortgage_Broshears M'P j STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C unty Township ear
OV i FOR DEDUCTION FROM ASSESSED VALUATION mV P a*- q \�-�
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State Form 43709(R12 L6-14) ld_4_4y
>' Prescribed by Department of Local Government Finance 1:::4-‘
fje ar f,ED
3TRUCTIONS: 1
.�be filed in person or by mail.
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. Co�41 nt Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ccr ,l J(n�
located on or before January 5 of the immediately succeeding calendar year. t 1. C r. Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought.,
See reverse side for additional instructions and qualifications. '/N/p`ty
Applicant(owner or contract buyer-see restrictions on reverse side) GIBBON COUNTY AUDIT—OR
Kassi L Broshears ,,? -�?-J 7-��- �, 7a3" aV`V 6/4- �w`
Taxing District Key number/legal description Record number Page number
Not yet assigned/2a-2-3-0-7--—nnn n75 Q24(Parent No.),Pt.SE 1/4 7-4-11 1.500 Ac ,(- 1E)
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year • March i,rCjyryear date of application legal or equitable owner?
C�tCCJJ tiyip 2/too [Z] Yes D 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 Assessed
iZ1 Real Property 0 Annually Assessed
7 Mobile Home(IC 6-1.1-7)
Naue`af Me—T¢iag�evor--contract C-.}/' / f
Address of mortga0e or contract seller(number and street,city,state,and ZIP code)
310 The Bridge Street 4th Floor Ste. A Huntsville, AL 35806
Name of assignee or other owner or holder of mortgage
•
Address of assignee(number and street,city,state,and ZIP code)
yes applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
,her county on property for
Indiana? ID Yes ❑No current year? ❑Yes it No
.,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
Signature of County Auditor County Date(month,day,year)
I/We certify under the penalty of perjury 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.
5ig Date(month,day,year)
AC//J��.ar�-t.(owner's ful ame) 6.34-k'0— .----3._ t 1 � 11 I I to
Full resident address of applicant(number and street.city state,and ZIP code)
240 East 1200 South, Haubstadt, IN 47639
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)
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The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. C6/_�.e� ���A
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