HomeMy WebLinkAboutMortgage_McNeece E STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�---,ms*a, County Township Year
4 FOR DEDUCTION FROM ASSESSED VALUATION
'% 7 .t,i' State Form 43709(R14/1-20) F tbsill7I 2020
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�`' =� Prescribed by Department of Local Government Finance ! e r
File Mark
INSTRUCTIONS: To be filed in person or by mail. Q C T 2 Py
® 2020 Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. E County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county wher- the property is
located on or before January 5 of the calendar
G I B S O N COUNTY AUDITOR
Applicant(o ner or contract buyer-see restrictions o reverse side) ?-A
Taxing District , Key number/legal description Record number Page number -5-
Assessed i���� o o? 6, -O(o - 07 - /d 0 - ODD, 7 ,� 7 -017 ao a-o `18 7
value 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 application _ legal or equitable owner?
/ all O b Elves ❑No
If no,what is his/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 property in question:Annually Assessed
':Real Property ❑Annually Assessed
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Name of mortgagee or contract seller c
Address of mortgagee or contract seller(number street,city,state,and ZIP code) ()- 0 ab
Drawer NO
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) Card N O. �l
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? Li Yes [it,No current year? III Yes III 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 Auditor County Date(month,day,year)
I We certify under the penalty of perjury that t//ire...,
abnd foregoing 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.
v Signal (owner's full name) Date(month,day,year)
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Full resident address of applicant(number and street,city,state,and ZIP code)
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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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