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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
County Township Year
a .ciiil s FOR DI;®l1CTION FROM ASS SS D VALUATION _
State Form 43709(R13110.15) C3SOn (-0'►') 2b2-O •
"`' ``'-, Prescribed by Department of Local Government Finance RECEIVED
I.
File Mark
INSTRUCTIONS: lTo be filed in person or by snail. � ��hLoviclJUN 1 9 - � Foria 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 rkj County Auditor
located on or before January 5 of the immediately succeeding calendar yi;ur. ❑ County Recorder
2) Mobile/Manufactured Hotnes not assessed as Real Property:Must file with tire County Auditor of the county
where the propotty is located during the twelve(12)months before March 31 of each your 1ite deduction is sought.
See reverse side for additional'instructions and qualifications,
Applicant(owner or contract buyer-see restrictions on reverse side) •
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Kenneth W. Lawson Jr. and Jessica Marie Lawson
lax g j)iblrlCI Key nunibor/legal description Recore number Page n b ,
1_S0 26-23-13-400-000,175-024 2020 0(4Uq
Assessed value of real property as of Mortgage I Contract indcbtocnuss unpaid as of I Mortgage I Contract indebtedness unpaic as of Is the applicant the sole
assessment date.current year assessment dale,current year I date of application legal or equitable owner?
IS96,000.00 ® Yes 0 No ,
If no,What is Ills/tier exact share of tntorost? — -- _ - I!ot4�I itue with someone other than spouse,Indicate with whom
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If name on record Is ditloront than that at applicant.Indicate below. is the property in question:Annually Assessed
1
I W Real Property❑ Annually Assessed
— Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
uoff Mortgage Company, Inc. -
'Address of mortgagee or contract seller(number and street,city,stale,and ZIP code) ---
1700 Magnavox Way Suite 220,Fort Wayne,IN 46804 JUN i 9 2020
Name of assignee or other owner or holder of morigagc
Address of assignee(number and street,city,slate,and ZIP code) •
GIBSON COUNTY AUDITOR •
Does applicant own property in 7 ry 11r.yes.what county? 1 fAlf at Taxing f)istricU I H.as this deduction been requeslec I it yes,state amount of deduction,
other county on property for
in Indiana? ❑ 'i Yes Nn1 I I current ear?• ❑Yes 0 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 recorders office)that Is the basis for the deduction.
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COUNTY AUDITOR_
Deduction approved in the amount el:
20 LU 20 10—_� 20 20 20 •
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Signature of County Au r — Co.nt•' Dale(me r
I,We certify under he penaity of perjury final the€bo've and ioreiuing tnfornletion is t and correct and that the applies t is a:esidenl of Indiana and
owner/contract buyer o1 the aforen:eniionod property can Gate ap,^1i.elion is filed.
Sign,lr re(owner's lull name) ale(month.day,year)
A.
Fun resident address of applicant(number and street.city.stele.4.1.55L ,Allosul..14L‘
coda)
5462 E 1300 S,Elberfeld, IN 47613
Person authorized by duly executed Power of Attorney or by IC b-1.1-12-u./ Dale(month.day,year)
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Address ei authorized per son (number and street.city,stale.and ZIP code)The penalties for parkin/can include imor isonmont cm to two and a halt vests and a line not to exceed.S10.000.