HomeMy WebLinkAboutMortgage_Ising �_,- �
� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
; FOR DEDUCTION FROM ASSESSED VALUATION
5,•7,--:t�me �� State Form 43709(R13/10-15) GIBSON �t-1 aolo
%,° Prescribed by Department of Local Government Finance
_
INSTRUCTIONS: I1 " File Mark
To be filed in person or by mail. Rf C pkCA �'t9 J 1 - Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is County 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 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant ner or- -a
contract
1 buyer-see rest'ctions_on r verse side) ,ry,
O® k"° 1 ��n l� •Sic
Tang Distri ey number/legal description Record number 'Page number
I-� 2C- S -13—/--0L►--00\ --O2‘ 20 2-02024
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortg e/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date o apblip tig{i legal or q ble owner?
`v Y0( U s ❑ No
If no,what is his/her exact share of interest? If owned with meone otheil than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: t'e property in question:Annually Assessed
�r�- I Pr.oak rri 'rrnuallyAssessed
-? �obile Home(IC 6-1.1-7)
tit
Name of mortga ee or contr sell r
Address of mortgagee or contract seller(number and stree, 't state,and ZP code)
MAY 19 2020
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) ' COUNTY AUDITOR
GIBBON
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes No current year? ❑El 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 0 20 20 20 20 20
Signature of County Auditor � County Date(month ay,yLar)
ill l (c.v.)
--A Date
,q Zoe.
I/We certify under the nalty of perjury that the above and foregoing information is try and correct and that the applicant is resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
/` Signature(owner's Date o ihdaHAar) l O .
Full resident addre of applicant(numb ran IP-cads)
211 W � SA vr--)- r 3 -L\R-t i
Person authorized by duly executed Power ofAttorney or by C 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
Tha nanaltiac for nariiw ran inrInrla imnricnnmant inn to two and a half vaarc anti a fina not to avraari aan nnn