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HomeMy WebLinkAboutMortgage_Fullerton (2) sBr`r-•' a. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year r FOR DEDUCTION FROM ASSESSED VALUATION a ,- `. = 1J�` ©2s L/, State Form 43709(R14/1-20) /^� lJ\J� . ---=•° Prescribed by Department of Local Government Finance VJ\ ` File Mark INSTRUCTIONS: To be filed in person or by mail. Form filed with: Filing Date: Form must be completed and dated in the Galen r 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 1 located on or before January 5 of the calendar year in which the property taxes Applicant(owner ocrfact bu r_see rest ' ns on reverse sidai� Taxing District '`J1'n\ P"J_ 'a number!//l legal lddescription R rd n be umr Page b -n_scrt-LiOo-v of . 6 .9;- 02r l �� Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage Contract indebtedness unpa d s of Is the ap I nt the sole • assessment date,current year assessment date,current year date of icatiq,0, 3 ^O legal ore uitable owner? (J�_ UYes ❑No If no,what is his/her exact share of interest? If owned with some other than 4ouse,indicate with whom If name on record is different than that of applicant,indicate below: I t•e property in question:Annually Assessed kReal Property ❑Annually Assessed FIL — Mobile Home(IC 6-1.1-7) Name of mortgagee or contr er Address of mortgagee or contract seller(number and street,city,state,and ZIP code) SEP 2 2 2020 Name of assignee or other owner or holder of mortgage i Address of assignee(number and street,city,state,and ZIP code) �n'ryr.�j11���j, ' GIBSON COUNTY AUDITOR Does applicant own property in any I If yes,what county? I What Taxing District? I Has this deduction been requested If yes,state amount of deduction other county - on property for in Indiana? ['Yes III current year? ['Yes ❑No A person is not entitled to this 'mortgage or contract indebtedness that is recorded in the county recorder's office(including an) � r` :order's office)that is the basis for the deduction. Drawer NO..�{1'I`h t Deduction approved in the amour 20 20 Card NO. D° 20 20 20 •11414 ure of aunty 1 or Date( t ay, a'`_ e7 ^ I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is reside t of Indiana and owner/contract buyer of the of re ioned property on date application is filed. SignaCure(own s full name) ber an treat, . Date(myp(�`t y, e Full resident address of ap icant(nu n ci , ate,and ZIP code) 2k69- c6 ,V-r ` � - 3n 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 oeriury can include imprisonment up to two and a half years and a fine not to exceed$10,000.