HomeMy WebLinkAboutMortgage_Muckerheide ,..1.-Eltt, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
1/1. FOR DEDUCTION FROM ASSESSED VALUATIONkt
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v:.:: ti' State Form 43709(R14/1-20)
;7 Prescribed by Department of Local Government Finance F_i_ e
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INSTRUCTIONS: To be filed in person or by mail.
Form filed ith:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought•. DEC 1 4 2020 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. LI County Recorder
See reverse side for additional instructions and qualifications. 'id-1
GIBSON COUNTY AUDITOR
Applica�n (owner or contract buyer-see resttictio s on reverse side)
Taxin istrict • Key numbber/legal description Record number Page number y 6 -JA .) - ,3°/-on l . L/ 3.3 ^0 R 2D ao ..5S$ 1
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applican sole
assessment date,current year assessment date,current year date of application legal ore able owner?
1 57 A S Yes ❑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 t property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller V
•
Address of mortgagee or c tract seller umber and street,city, ate,and ZIP code
Name of assignee or other owner or holder of mortgage 0 { O ^ p ,C
Address of assignee(number and street,city,state,and ZIP code)
Drawer NO.....
Does applicant own property in any If yes,what county? What Taxing District? Has ction
other county on r
in Indiana? ❑Yes ❑No cur Card NO.
A person is not entitled to this deduction unless the person has a balance on the person's m ,*'••.••••• .,,, :county
recorder's office(including any home equity line of credit that is recorded in the county recoi •
`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 e abofve and 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.
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\/ Signature .-ner' ame) z Date(month,day,year)
/Z-f/j/�LoZC�p.iloo
u dent a dress of appli nt(n tuber and reef,city,stat and ZIP code)
•erson authorized by duly executed Power of Attorney or by IC 6-1.1-12-0. 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.