HomeMy WebLinkAboutMortgage_Auberry (2) �•*a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
oQ/�,;�'`,Q County Township Year
,_ FOR DEDUCTION FROM ASSESSED VALUATION RECEIVED I I�
- 1:Vg State Form 43709(R14/1-20) `SQi) v-�wS,I-� . 2Q2�
yam-- Prescribed by Department of Local Government Finance
' 1
JUN 1 1 2020
11 File Mark
INSTRUCTIONS: To be filed in person or by mail. �C A.) ob :t ��
U Form filed with:
Filing Date: Form 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 property is
located on or before January 5 of the calendar year in which the property taxes are first due and payable. County Recorder
See reverse side for additional instructions and qualifications.
Ap icant(owner or contract buyer see restrictions on reverse side)
GLEN 4- I2b,6�i� L u e2y
Ta ' g Djct Key number/legal description Re ord numb r Page number
�s 1Q3 {/ - 016-Its-d3-'-IOo -001 ,l780 -oc2� _4•0712
Assessed value of rea�property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applica the sole
assessment date,curt nt year assessment date,current year date of application legal or equ' ble owner?
9gE' O Yes ❑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 t property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
�—er � r
EV NSkin , , � �L �Uiviox) FILF ill'
Address of mortgagee or contract seller(nu ber and street,city,state,and ZIP code)
d a58 E 35o S P ,iC fbm am 4 9 t/10 ' JUN 112020
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
GIBSON COUNTY AUDITOR
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 Audi ' 'll !' ' County 1 1 Date(p7o tt,Id112r) ^ —I/We certify under the penalty of perjury tha -- ,.. : -nd foregoing information is tr e a d correct and that the applicant i a redent of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Sig (ownerAfull na ) Date(month,day,year)
Full residen address of appli rt(number and street,city state, IP code)
o2�5. e t Sao 5, -, •()c e 1-, ) , 9-r? b 2 0 •
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.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
N me of applicant Name of mortgagee or contract seller
L� OQT1�1 L. /?U/3�2 LvA,vsv u.k /Ma-1 s FLD c rw zi
Date 'led wi( h,d year) Amount of ind-•.- . Taxing District
Jr V.,` a r10 i)- 110_S c '
Key number/le al description .i.... ,
0- I a- as-400 -001 . �oa')
ac 202 0 -- JEC
Signature of CounAuditor/Coun Recorder JUN icin�'1 Date(month,day,y0'
GIBSON COUNTY AUDITOR