HomeMy WebLinkAboutMortgage_Quinlin .,...0_, .. , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
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State Form 43709(R14/1-20) TS Di\ . OM 'A Oal
L--..: 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. 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 due and payable. County Recorder
See reverse side for additional instructions and qualifications. •
ApKicapt(owrier or cor,cjbuyer-see restrictions o_weverse side)
Ka9eVt.C 'K -P
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Taxing District te- NIKeraer 4- r)
/legal description Record number Peylisber
0 2-S 24)-12.- n-tot- 0oo.001----o 2-S (*Lc:,2 i Assessed
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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 o application_ cal legal or q itable owner?
If no,what is his/her exact share of interest? ff Ej No
If owned with s meone ither thel spouse,indicate with whom Yes
If name on record is different than that of applicant,indicate below: I e property in question:Annually Assessed
Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortiGetir contract seller,10.411(....„
•1 .<10, 21
olk.
Address of mortgagee or contract seller(number and street,city,state,and yitctekiez/ ir:2
GIBSON COUNTY Aui:)iTOR .."
Name of assignee or other owner or holder of mortgage
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 deductitl , n requested If yes,state amount of deduction
on property for
i'.ith er Indiana?county Eves CI No current year? Yes El No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or cfonYact 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 ---1 20 20 20 20
Signature of County Auditor 31.w) 0, ins c.
County 1
ii.diko 30(1 Date(month,day,year)
T. •n.
I/We certify under the penalty of perjury that thU e ove and foregoing information is tru and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
X Sig _ re wner's f II name) Date(month,day,year)
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... %.ri• °-Z-°7.,,‘ .
till,re id4en addr ss of appli umber an treet,city state,and ZIP coide)
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Person authorized by duly executed Power 6f 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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