Loading...
HomeMy WebLinkAboutMortgage_Canillas �R: STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS .� „�•4, CountyTownship y.. 'siP � Year � FOR DEDUCTION FROM ASSESSED VALUATION(ik Stale Form d3709(R1,/I-20RECEIVED �O� ©�� ;ga y" .Prescribed by Department of Lccal Government Finance _u INSTRUCTIONS: To be filed in person or by mall. I Q'i 1 — OCT 2 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 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. Applicant(owner or contract buyer-see restrictions on reverse side) cec_ED ask-1-1--G_ L c n i o (c n_-1 I a s Taxing Distriyt Key number/legal description Reco34, number I Page number Assessedvalue of real property as of Mortgage I Contract indebtedness unpaid es of ,Mortgage I 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? 1 3 g, co e . 0 o EYes ❑No If no,what is his I 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 property In question:Annually Assessed 0 Real Property ❑Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller FTL ) Address of mortgagee or contract seller(number and street,city,state,and ZIP code) 0�� �Or 41 2 qn Name of assignee or other owner or holder of mortgage ' Address of assignee(number and street,city,state,and ZIP code) /�� nC- - Q1t GI SO�I_CO_J1 TY AUDITOR Does applicant own property In any If yes,what county? What Taxing District'? as this deduction been requested If yes,state amount of deduction other county on property for in Indiana? ❑Yes 121C10 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 Audit . � 1 County 1 Date(month,day,year) 641w\ V 1 JO n 10 2-L`20 . II We certify under the penalty of perjury t at the above and foregoing information is\tctie and correct and that the applicant is a resident of Indiana and owner!contract buyer of the aforementioned property on date application is filed. • Sig�;re(owner's full name I Date(month,day,year) �,!J a �,io aa4A-AL, lfGb1b21Zbzv___ Full resid nt address of epp cant(number and street/city,state,and ZIP code) Person au horized by duly ecuted 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 perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Name of applicant _ , % i)1�0 • Name of m or contract seller J '�Vhl -ry t,Date filed(month,day, ear) Amo r 140). d e k Taxing District Key num er!legal description 7 c) Signature of Cou� County/Coy Reco 2� County \ Date(month day,year) N M� 1 - �So`n • IQ• Z� ?�2 • o " tit GIBSON COUNTY AUDITOR