HomeMy WebLinkAboutMortgage_Lucy .ex-*,,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDN
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�_ FOR DEDUCTION FROM ASSESSED VALUATION p
"\��'�:.L i State Form 43709(R14/1-20) .3tryikr ....,,,10 2:8 e2,10 el.^0
' ;e i -e Prescribed by Department of Local Government Finance
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INSTRUCTIONS: To be filed in person or by mail. 7 2020 File Mark
Form filed with:
Filing Date: Form must be completed and dated
T79 District Key number/legal de ription Record number Page number
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Assessed value of 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 applicationQ legal or itable owner?
/ O00 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 the property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
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Address of mortgagee or contract seller{number and street,city, ZIP code) 4-
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Name of assignee or other owner or holder of mortgage
DEC 2 1 2020
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any ' If yes,what county? What Taxing District? Has this deduction be requeste 4I4' ;S te'amount of deduction
other county � on property far PIW�� COUN 9 Y �...�:i R
in Indiana? ❑Yes Ste'"" current yearf Ye
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contr f 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
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Signature f County Auditor ` County 1 Date(mo h,day year)
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I/We certify under the penalty of perjury that th and foregoing information is tru and corm Ili thelapli�c rt.' a res dent of Indiana and
owner/contract buyer of the aforementioned property on date application is filed. 7 1
Signature(miner's full na ) jA,..,,u/j aCe din,day,year)
` /Full rest'en address of applicant tuber and street city,state d ZIP code / ` // �/1 2020
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Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Datej(mo r day,year)
Address of authorized person (number and street,city,state,and ZIP code) GIBSON COUNTY AUDITOR
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