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HomeMy WebLinkAboutMortgage_Hickrod (2) a�' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year _ _ FOR DEDUCTION FROM ASSESSED VALUATION p f\ ..-- (R1310-15) GIBSON 1 1,A� Z U20 .,: State Form 43709 I S's esr Prescribed by Department of Local Government(IFinance INSTRUCTIONS: i j a i'' CN�Gtn) File Mark To be filed in person or by mail. �� Form filed with: Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. *aunty • Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is Auditorlocated 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 31 of each year the deduction is sought. See reverse side for additional instructions and qualifications. Appr nt(owner or contract buyer-see restrictions once verse side) L ,Olt_r •CI b ' dit- l4 t r �1 \ ,i C C zing District Key umber I legal description +-� Record number P e umber 'Wing District a,�,a-l�.-08j - 109 - 1 .c19q-- o, �/...0 t��sD . Assessed value of real property as of Mortgage I 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 civof or equity le owner? 'Alt 1 5/V1 ��00,E es CI No If no,what is his I her exact share of interest? If owned with some other than spouse,indicateAvith whom Uarr e_on-record-is-different than that_ofapplicant,-indicate-below:=- -- — ---1 Is the- perty in question:AnnualiyAssessed- - -- _-- eai Property ❑ AnnuailyAssessed Mobile Home(IC 6-1.1-7) Name of mortga ee or contract seller UDC- y-ia,r0010 Address of mortgagee or contract seller(num nd street,city,state,and ZIP code) to }? .,l... Name of assignee or other owner or holder of mortgage A. 0 • Address of assignee(number and street,city,state,and ZIP code) APR ® � 2020 ' • Does applicant own property in any If yes,what county? What Taxing District? Has t ls;deduction been requested if yes,state amount of deduction' other county on proyfoc •in Indiana? ❑Yes aN'o • curr t ? o • A person is not entitled to this deduction unless the person has a balance on the per {aSa a tinri qt c debtedness that is recorded in•the county recorder's office(including any home equity line of credit that is recorded in the county recorder's°Mce Hai ROB,the deduction. •COUNTY AUDITOR . ' Deduction approved in the amount of: 20 20 20 20 20 20 20 Signature of Coun%A••itor County Date(month,day,year) A er,il 0 Gy SQL Lt 3 202.0 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 t e aforementioned property on date application is filed. nffatur ((on r�elnarnej o � © Date(month da _Ye Y .) , - - - et0•/ 11 7 L•• _ _ - - ' • - -©-`3 L; -/- -2.:0 2-0 su 1=residentaddres cA�ep+pucant(number and reef,c ,state,and. 1P code) 1 J' CI I N((1 r tom-C.C.,. DC.1 r'lY1f -�-` -1 -1 0 _._..._ Person authorized by duly execut ower 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. RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Na a of applicant arrie m agee or contract sell l cam+,�-c 'D. 1�u- ,r n , E t s 1C�--Q 0 Date filed(month,day,year) mount a (p Taxing District _IA•3.22fl. . t -4C 001 P r. k V\cam- r1 Key j number description (6- 1 e !t._.r N Gy,�t - '4`���_✓�'�} fl 1 0 "'r' +--�ca�1 i Signature of County Auditor!Co corder ou Date(month,day,year) .Smite �li ON LI.3-1.02,0 . GIBSON CO TORRECEff711111 APR 0 3 2020