HomeMy WebLinkAboutMortgage_Kelle (2) �,-� �, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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�;:-_ _��. FOR DEDUCTION FROM ASSESSED VALUATION
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..:a State Form 43709(R14/1-20) a' ,i
�`„g�`. Prescribed by Department of Local
Cou,,ty Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the p rty is -
located pn or before January 5 of the calendar year in which the property taxes are first due and pa r�; �0❑ ou�nty Recorder
GIBSON CO "�'�
See reverse side for additional instructions and qualifications. UNTY AUDITOR
Applican wner or contract buyer
� �c see restrictions on reverse side) ��
Taxin District Key number/legal description Record number Page number
0, 60 -/7- 02/ Ze'o - c4`i. 693? . bzt 2-49,?( z. 36
Assessed value real property of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of la the applicant the sole
assessment dat current year assessment date,current year date of application legal;or equitable owner?
l A 0) 0O 0 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 roperty in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract se r
Address of mortgagee or contract seller(number and street,city, ate,and ZIP cod 7,-.2 - --- --
Name of assignee or other owner or holder of mortgage /��
Address of assignee(number and street,city,state,and ZIP code) rawer 1`T O CJ^/�/ O `
Does applicant own property in any If yes,what county? What Taxing District? Has this c I. �T O. Uf3
1 VVVLLL/Jother county on properC
in Indiana? ['Yes No current yt
A person is not entitled to his deduction unless the person has a balance on the person's mortgage or contract/naeoreoness MOIL ra imnlit m,.......,,..__.sty
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)
`yli1A,12e-1 Zei a'r'/ tig Son -5 .2d2
I/We certify under the penalty of perjury that the ai=d 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 ture(o n s full nala I Date(month,day,year)
)(Full resident address of applicant(number and street,city,state,and ZIP code)
7gO6 S . UV:I (vwbrboY, c.fi ow�i,-,S1 i(C / // Li. 766-3
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)
-rt... .,....,.rar.,,,s...,.......,,....,..,,.i,...J,,,... ' me rF..r F.,h.re, r.f n h&K,.more nnri m firm not fn mvromri Al ruin