HomeMy WebLinkAboutMortgage_Helfrich (2) 0,,<,� s STATEMENT OF MORTGAGE OR CONTRACT INDEBTED Co I Township Year
�, ��; FOR DEDUCTION FROM ASSESSED VALUATION
3' _1t I= State Form 43709(R14/1-20) L 1/'±
''.ell Prescribed by Department of Local Government Finance
INSTRUCTIONS: To be filed in person or by mail. S E P 2 2020 File Mark
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 w e
located on or before January 5 of the calendar year in which the property taxes are first d ❑ County Recorder
GIBSON COd TY AUDITOR '
See reverse side for additional instructions and qualifications.
Applicant
or contra buyer-- restri�nson verse side),
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Ta n District Key number/legal description Record number Page number
02 & - i9 - 3 -2, • io/ - 000 i641- o� ci a 2.35Y
A essed value of real property as of Mortgage/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 ' . . legal:or equitable owner?
/3 ry, -Co v ❑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 the roperty in question:Annually Assessed
tWeal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and stye ,city,state,and ZIP code)
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Name of assignee or other owner or holder of mortgage � (� � - ____
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Address of assignee(number and street,city,state,and ZIP code) . / Kt /
4 cSS.'t
Does applicant own property in any If yes,what county? What Taxing District? aduction
other county
in Indiana? ❑Yes kcl No (21((11/�r, y_�
A person is not entitled to this deduction unless the person has a balance on Mt � the county
recorder's office(including any home equity line of credit that is recorded in the
COUNT) /3 4,Soo
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signs re of County Auditor County Date(month,day,year)
I/We certify under the penalty of perjury that thf above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
` Signature( (owner's(ull Warn ) 1^ Date(month,day,year)
�Y\ 1 s }'��1 J
Full resident address of applicant( ber and street,city,state,and ZIP ode)
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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)
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