HomeMy WebLinkAboutMortgage_Gabbard (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
' `R . FOR DEDUCTION FROM ASSESSED VALUATION
'i ` State Form 43709(R13/1 a15) ,/�*\J�� 10� /� �`II��,,
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' � Prescribed by Department of Local Government Finance
INSTRUCTIONS: \
ACounty Auditor
• located on or before January 5 of the immediately succeeding calendar year. ❑ County 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 39 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Ap t(owner or cot)*ct y r-see fictions on reverse side)
Taxing District Ay number l legal description Record numlaer Page numbs
le\ NA 6,\\-B-2 -000 . Z87- 02 2O(R 51C -
Assessed value of real property as of Mortgage!Contract indebtedness unpaid as of Mortg ge 1 Contract indebtedness unpaid as of Is the applicant the sole
assessmentdate,current year assessment date,current year date applica'o 60 legal o e itable owner?
��� q , Yes ID No
If no,what is his I her exact share of interest? If owned with meone other Ulan spouse,indicate with whom
If name on record is different than that of applicant,indicate below: I th property in question:Annually Assessed
Real Property 0 AnnuallyAssessed
J\ Mobile Home(IC 6-1.1-7)
Name�Qf gage dO+n03v1 k • FITJD
9
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner nc hnhei'K.,°iTrt71'it v, - - - DEC 2 7 2019
Address of assignee(number and
� 0 / q 5/ 0. . -
I $ P CO PJTY AUDITfR
Does applicant own property in an s is a ucfion requested f yes,state amount of deduction ,
other county property for
in Indiana? ❑ Drawer NO
Yes ❑Ni rrent year? rA Yes ElNo
A person is not entitled to this t iortgage or contract indebtedness that is recorded in the county
recorder's office(including any rder's office)that is the basis for the deduction.
Card NO.
Deduction approved in the amount
20 20 i 20 20 I ,I . 20 ' 20• 20
Signature o t`Q tyA itor ( County \. `�� Date(month,day,year) (�
i 1 ""- `SV 12r-Z1_‘C1
I/W rtify 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 ntract buyer of the aforementioned property date application is filed.
Signaler wner's full name Date(month,day,y r)
)c.,
�,�yy1 IZ�2?—�
Full residentdress of applicant(numberand4c. .
etc scat and ZIP code '
%DI rk\�emsa n )
Person authorized by duly executed Power of Attorney or by iC 8-1.1-12.0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
The penalties for penury can include imprisonment uo to two and a half years and a fine not to exceed S10.000.