HomeMy WebLinkAboutMortgage_Parke (2) ,
�� r-„� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
a. Cpunty Township - Year
. . li,;- FOR DEDUCTION FROM ASSESSED VALUATION
'() C CI C 1010
1. 1 State Form 43709(R14/1-20) UQ
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"18"''`' Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail.
Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. ,PQ County Auditor
Must be fried 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 ide for additional instructions and qualifications.
Applicant ner or co tract buyer-see r rictions revers side)
Ta ' g strict Key number/I gal description Record number Page number
cti; Qt// -doo-�/a? . o 06 0 ' .
Assessed value of real prope y as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the a Ii nt the sole
assessment date,current year assessment date,current year dat f ap (cation . legal or 'table owner?
al, �7 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-•-property-in-question:-Annually-Assessed—
014 Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller /32 t IF I
r ., ,n
�Address of mortgagee or contract se r(number and street,ci ,state,and ZIP code i• )
Name of assignee or other owner or holder of mortgage DEC 21 2020
Address of assignee(number and street,city,state,and ZIP code) .,-- t-"--
1/i,i -.
GIBSO ('OUNl Y AUD -{ pp
Does applicant own property in any If yes,what county? What Taxing District? Has this deducti n een requested -ff yes,siate 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 n ct 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 r 20 20 20 20 20 20
Signature of Cou uditor 1 County Date(month,d ,year)
I/We certify nder the penaltitty o • at the above and foregoing information i tr e and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
(-Signature(owner's full na e) Date(month,day,y ar)
fits
4Full-residentadd eI.`ofjapplicant(number and street,city,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)
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 f apRi nt �.� 47.44..." Name o o ee or c tract Iler/
1.L.4-, till t
Date filed(month,day,year) Amount of'ride e e . Tax z Dist. t / AO
Key nu ber/leg description
'� •'" ?oo-eaZt DEC 21 2020
Signature my Auditor/Co Rec rder Cou 1 . Date(month,day ea
/70 GIBSON COUNTY AUDITOR