HomeMy WebLinkAboutMortgage_Glaser .M5"gt STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
°�°"`~_,�; FOR DEDUCTION FROM ASSESSED VALUATION County Township Year
>a 026?:a.,:.Z State Form 43709(R14/1-20) so n
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�a Prescribed by Department of Local Government Finance
^ • 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 year in which the property taxes are first due and payable. County Recorder
See reverse side for additional instructions and qualifications.
Appl�t(owner or
r contract buyer-see rest�tions on reverse si
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Taxing District ( Key number/leg‘aLiiescription Record number Page number
026' . —19—Vg-101-000 . 10.-- 02C. 90Zo • y.02
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 assessment date,current year date of ap li r�._ ,, legal or itable owner?
SYes ❑No
If no,what is his/her exact share of interest? If owned with somcbne other1han spouse,indicate with whom
If name on record is different than that of applicant,indicate below: I e property in question:Annually Assessed
?' I Fri
p y ❑Mobile Annually Assessed
FT ,
th Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller st .. .., _ �
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Address of mortgagee or contract seller(number and street,city,state,and ZIP code) O C Tr f 6 2020
Name of assignee or other owner or holder of mortgage /
Address of assignee(number and street,city,state,and ZIP coda) GIBSON COUNTY AUDITOR
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction 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 20 20 20 20 20 20
Signature of County Au for s Cc* County t. Date(monOth, a year) /� ^
IC
1,We certify under the penalty of perjury that the above and foregoing information is and correct and that the applican�is aresident o Indiana and
owner_/_contract buyer of the aforementioned property on date application is filed.
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Date(month,da,year)
7 /®� 13-2CO2 o
Full resident address of licant(number and stree ity,state,and ZIP code)
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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