HomeMy WebLinkAboutMortgage_Elliott (2) .•"' c STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
Stil FOR DEDUCTION FROM ASSESSED VALUATION / /-
3 l' Stale Form 437119(R13/10-15) urr Pj O- 00k6502 20/9
%c l Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: Form,filed with:
To be filed in person or by mail. rRV-'\
Filing Dates:1)Real Property: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 0 County Recorder
property is located on or before January 5 o1 the immediately succeeding calendar year.
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 hvelve(12)months before March 31 of each year the
deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Sarw , t.Ciobf 3 Odsea Fe/ailI
Taxing District Key number I reamcescnpuon Record nu er Pa a ugib r
"�ohnsort I 26-22-12- -O02.270-02Y 201 b� �
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 �1 equitable owner?
qq
318; Jt/, 00 ❑ 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 I Is �estlot essed )
Re ro .rd1''JJJiJA'.'++JJ.❑ ua A ssed
e(IC 6-1.1-7
Name of mortgagee or contract seller
Ou C*1I1 /.o647s,,. .c' AUG 15 2019
Address of mortgagee or contract seller(number nd street,city,state,and ZIP code)
1050 Wired ver2Ue, Pe roil AI--1- TEE
Name of assignee or other owner or holder of mortgage
GIBSON COUNTY AUDITOR
Address of assignee(number and
//street,city,state,and ZIP code)
Does applicant own property N apy If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county (J on property for
In Indiana? ❑Yes 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
Signature of County Audi' County '- Date_IF , y,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant' a r sident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
� S' nature/(o '�er'rsPfulll name) (`��.I� P�y/ry�� (/, /1 rF Date(month,/tl�/y,ye //y�
�I taddres's f ell nt(number Qand"sLeeGa e . Pcod rI��� QG oLL,� O2' /"
/1 gig5. /50 W, Paabs xoi', .r.,✓ 97639
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.