HomeMy WebLinkAboutMortgage_Boxdorfer STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS - County i Township
Year
(A.- lit FOR DEDUCTION FROM ASSESSED VALUATION
/ State Form 43709(R14/1-20) Gibson 2020rescr Prescribed by Department of Local Government Finance '
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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. El County Recorder
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See reverse side for additional instructions and qualifications.
Applicant •vinqr or contract buyer-see restrictions ori-reye.rse side)
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I„lir istrict Key dumber/legal description Record number Page number
Iv ,i4ufle, 12l,- J.Z- 102 -137C1V-ct7 - 2,e. 0 .
Assessed value of real property as of Mortgage i Contract indebtedness unpaid as of M g e/Contract indebtedness unpaid as of Is the a li________________t the sole
1 assessment date,current year assessment date,current year te of pplication legal or !table owner?
Yes Li No
If no,what is his/her exact share of interest? It owned with someone other than spouse,.indicate with whom
If name on record is different than that of applicant,indicate below. Is the y in question'Annually Assessed
l ---FIL-E-13- - eat Property CI Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or ntract seller
Address of mortgagee or contract seller(number and street,city state,and ZIZE1
C 04 2021
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Name of assignee or other owner or holder of mortgage
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'Address of assignee(number and street.city,state.and ZIP code) GIBSON LA)UitstrY AUDITOR
Does applicant own property in any If yes what county? What Taxing District? Has this deduction 4 requested If yes state amount of deduction
other county — on property for
in Indiana? L j Yes Lil No current year? Yes El No
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A person is not entitled to this deduction unless the person has a balance on the person's mortgage or co t act 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) ha is the basis for the deduction.
I _ COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
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I Signatu e of C unty Auditorc4--- County Date(month,day.year)
Y/'2 00/
1 I I VVe certify under the penalty of perjury that the -bo -and fol,"egoing i formation is true and correct and that the applicant is a resident of Indiana and
o.,..ner/contract. - of the aforimenhoned pr,• on... eipplica,; is file4.
4lig ure(own;s r /
,' Daternth, ay year)
I ' do.40Y r A ... a, Ari / or N" /- z.,--- /
.11M?", eii•ent""a!dol.. te • •re• op bent(n krer and s 76:...c sate.arid ZIP or:4'
, '01 V Mk_ 14,j)1 ° rit-c,A. 1-1-76,70
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Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0 7 Date(month,day year)
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[-Address of authorized person (number and street.city state.and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S/0,000.