HomeMy WebLinkAboutMortgage_Creek (2) E.I STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
��;���.� Coun Township Year
,,t.- %�,:t; FOR DEDUCTION FROM ASSESSED VALUATION Y 1�Lf++� State Form 43709(R14/1-20) FIE.\;, 0 12.cao
4�. Prescribed by Department of Local Government
O C T 14 2020 File Mark
Foled 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 the pr pe .sue
located on or before January 5 of the calendar year in which the property taxes are firs ❑ County Recorder
See reverse side for additional instructions and qualifications. G I B S O N COUNTY AUDITOR
Applic owner or contract buyer-see res •ctions on reverse side)
Taxing District Key number/leg description Record number Page number
d6_ <<- / 7 - oo - DOD. 3 � s- D )L/ 02o/ q /OC 3
y
Assessed val of real pro rty as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current ar assessment date,current year date of application legal ore itable owner?
Isall n 6 d Yes ❑No
If no,what is his/her exact share of interest? If owned with someone otherthan spouse,indicate with whom / \
If name on record is different than that of applicant,indicate below: lathJJ property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller^ ^ C3�
Address of mortgagee or contract sellerr(number and street,city,state,and ZIP code) 1
Name of assignee or other owner or holder of mortgage ppl� ((((��
Diatiti/crNO...... V!.. ......
Address of assignee(number and street,city,state,and ZIP code) .. I /��
Card NO. ... ..l.cx ..c6 '
Does applicant own property in any If yes,what county? What Taxing District? Has this dec ......
other county on property
in Indiana? Yes No
❑ current year I
A person is not entitled to his deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in me courtly
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 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I/We certify under the perialty of perjury that the aboveforegoing 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.
kSigna a(owner's full name) a Date(month,day,year)
)(Full resident address plicant(number and street,ci tate,and ZIP code)
X47U� / �a )i , ���� `--I 7 C�
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 nenalfiac fnr April,/,,ran inr•IIIrde imnn.cnnment lln to twn and A half VearC and a fine not to e,rr`eerl gin Ann