HomeMy WebLinkAboutMortgage_Holder (5) 674� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownshipYear
.� _ FOR DEDUCTION FROM ASSESSED VALUATION
f's.` "i' State Form 43709(R14/1-20) Gson 028 2020
" / Prescribed by Department of Local Government Finance
„,s
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. IZI 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
Holder, Gerald W/Janet E
Taxing District Key number/legal description Record number Page number
028 26-11-01-403-003.008-028 2Dz/ 'f!/
Assessed value of real property as of l Mortgage/Contract indebtedness unpaid as of I Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,�.,�o+„. Lassessment date,current year _ date of application legal or equitable owner?
10 Yes ❑No
/-41UL_
If no,what is his/' t� � ac &La 0one other than spouse,indicate with whom
IJJ\
If name on record / Is the property in question:Annually Assessed
®Real Pro erty ❑Annually Assessed
J�i �� -yr 7,- Mobile Home(IC 6-1.1-7)
Name of mortgage
I Li
ETFCU A -
Address of mortgo I Lill DEC 222010
Name of assigner '
/I/ (
Address of assigr )l ° M--
GIBSOI`M CO°J'TY AUDITOR
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
oin er couty ❑Yes ❑No on n yrtyea for IYes ❑No
in Indiana? current year?
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 IP 20 20 20 20 20 20
Signature of County A 41 County Date(month,day,year)
LA gson 12/22/2020
I/We ce fy u der the penalty of perju that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract.uyer of the aforementione n date application is filed.
Signature(ow/er's lI 'ame) ,, Date(month,day,year)
(j / '/ 12/22/2020
'e ident ddress of applicant n r and street,city,state,and ZIP code)
103 N Embree ST, P'ton, IN 47670
Peron 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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