HomeMy WebLinkAboutMortgage_Neyhouse 06-*,4. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
r.?%; ; FOR DEDUCTION FROM ASSESSED VALUATION
a . •;w.. i= V)
L.. L;� State Form 43709(R14/1-20) .��' 1
;9--
...1 /O;(31
th, o Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail.
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
Applicant(ow r or contract b`1er lee restrictions n reve e side)
•Nron o ) dwoe •
Taxing Distr' t Key number/legal descript Record number Page num er
o1 1-- . 26- 2--03 - Li 00-00 y - �l l S--- 42 2a2o u02.6 .
Assessed 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 assessme date,current year date a on pp legal o able owner?
OOV� • es Ill No
If no,what is his/her exact share of interest? If owned with s meone Ether than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: a property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract s lei n k F
ILED
Address of mortgagee or contract seller(number and stre t,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage O C T 132020
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 aeduction been requested If yes,state amount of deduction
other county on property for
in Indiana? Yes ❑No current year?❑ ❑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 p,2O
20 20 20 20 20
Signature of County Au• `� County Date(month,day,year)
1 '�/A\ � � 'n (O L V2p7"0 -
I/We certify under e penalty of perjury that the above and foregoing information is tru nd 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 full name)4
Date(month,day,year)
a��.--��,, Q , �, � , p ,,pt,,o > > 0 . 13• �aQ
Fullside"�Aaddre a t.t(n mberand te1t,ci fate,and ZIP
23�J((7�Q��' C JJ,V► 11
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)
Thp npnaltipc fnr npr6w ran include imnricnnment on in twn and a half years and a fine not to exceed S'10.000.