HomeMy WebLinkAboutMortgage_Dierlam (2) .M "•*.9, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownship
� . p Year
v :ter; . FOR DEDUCTION FROM ASSESSED VALUATION 202n
State Form 43709(R13/10-15) GIBSON
� -4.ei---.° Prescribed by Department of Local
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.
Applic t(owner or contra t b -see restrictio e�erse side) 2-0 ^ 1
3cvne<s _ 5 \Qvc _ L G
Ta ' Dist Key number/legal description Record number Page number
2 6 2° —O r' k ap --000. 1 �3 -- 0 01
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/ ontract indebtedness unpaid as of •Is the applicant the sole
assessment date,current year assessment date,current year date of ap cation CP legal o unable owner?
2-S 100 0 •
Yes ❑ No
If no,what is his/her exact share of interest? If owned with som one other titan spouse,indicate with whom.
If name on record is different than that of applicant,indicate below: I-'le.rope '• in question:Annually Assessed
■ R T_-_41eal Pro.-� El Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortg or n
Oka. .tract seller
FT ii
Address of mortgagee or contract seller(number and street,city,state,stta and ZIP code) tr�
Name of assignee or a ,0 -0 ' J/ % / J U N 2 6 2020
Address of assignee(r
Drawer NO Ax.coatt------
Does applicant own pri strict? 1-1RtMaINVc0 Teiucktglef) 0E4,state amount of deduction
other county on property for
in Indiana? YE Card
a i-d N O. current year? ❑❑ Yes • ••o
A person is not entiti n the person's age or contr- ' debtedness that is recorded in the county
•
recorder's office(inc „ - _ the c .ounty recorder's o ice at is the basis for the deduction.
•
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County 1 .SQY- Date(mor}(hldan r)
Cr)
I/We certify under the penalty o perjury that the • - . oregoing information is tree tnd correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
NSi ure(ownerulme) Date(rpQnrh daye�r)
14 I; fr{t//fVJ t/U' II1'cJ` Z�2
F IF aside t address of a plirant(number and street,city,state,and ZIP code)
GSPA DSO OS c - �1.-- 6 . - 6 )1q
Person authorized by duly executed PowerdAttorney 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.