HomeMy WebLinkAboutMortgage_Brown (22) .0,En•TF STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�vri, FOR DEDUCTION FROM ASSESSED VALUATION County Township ///�Y/e�ar��/��
M?`.i`i l Yin,�_ �------yyyy i' a
///'''��� /1 jV VL I' State Form 43709(par/1-20) - i', ,p "/ {/0
%� � Prescribed by Department of Local
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 du nd pa -,: — ❑ County Recorder
TM
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Applicant(owner or contract buyer-see restrictions on reverse side)
4 A
T ng District y number/legal description Record number Page number
a ../ a 5 - AOO - 00 /. ) 3 /- 0.z 7 02 Oil-0 Co I
Assessed value of reafaso pro f Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant th le
assessment date,current year assessment date,current year date of application legal or equit owner?
al ,3D pa es ❑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 the property in question:Annually Assessed
eal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller r
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage Drawer NO _0a.0
Address of assignee(number and street,city,state,and ZIP code)
1 Card NO. Li[, _
Does applicant own property in any ' If yes,what county? What Taxing District? Has this deductio
other county on property for
in Indiana? ❑Yes o current year? LJYes Li mu 1
A person is not entitled to his 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 ttfat th bove 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.
Si/gn/a (ow er's ful nAgfi Date(month,day,year)
Full reside dress li t mbe d street,city,sta a nd ZIP code)
Person authorized by duly executed Power of Attorney or by I 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
The nenalties for neriury can include imprisonment un to two and a half years and a fine not to exceed S10.000.