HomeMy WebLinkAboutMortgage_Jobe STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year _J
ei,iti:, FOR DEDUCTION FROM ASSESSED VALUATION I
State Form 43709(R14/1-20) Gibson 1-1.90.4.54.-dt 2020 I
Prescribed by Department of Local Government Finance
INSTRUCTIONS: To be filed in person or by mail.
Lii7j 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. 0 County Recorder
See reverse side for additional instructions and qualificati
[Applicant(owner or contract buyer-see restrictions on revers '
.
I Taxing District Key numbll description Record number Page number
o 1 0 heii 34-efod-coo- 3igi-009 020..11 5_/7-7
IAssessed value of real property as of •-ge i Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
1 assessment date,current year %Ws- ent date,current year date of application legal or equitable owner?
---- (60
es 0 No
If no,what is his/her exact share of interest? COO
It name on record is different than that of applicant.indicate below i-i --- If owned with someone other than spouse,indicate with whom
Is the pro ert in q ly Assessed
Pr erty A Assessed
. . , ome(IC 6-1.1-7)
Name of mortgagee or contract seller
--Zi;/IOW Nye° 6 OC.-,1 S L LC--
Address of mortgagee or contract seller(number and street city state,and ZIP code) DEC 13 2021
Name of assignee or other owner or holder of mortgage
Yht.e.A4frd a-.1%-,akiozed
Address of assignee(number and street.city.state.and ZIP code)
Has this dedu yes,N-t sYt-a-AUD—te arnon.un:oRf deduction
Does applicant own property in any If yes.what county? What Taxing District?
other countyon property for i n eer,GreleguSesOteNd COI
in Indiana? ]'i'es Li.41(ilo current year? Yes D No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or co t t 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)t at is the basis for the deduction.
I , COUNTY AUDITOR
Deduction approved in the amount of.
20 20
1 20
20
20 20 20
I Signay AurilAdoe_ 0 -17 1 County .. Date(month.day,year)
1 - & i b son /D-43-0 I
1.---- I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
I owner/contract buyer of the aforementioned property on date application is filed.
I Si g 'natur,kowrier's full name) Date(month,day year)
'
ta--\ '- - D-- /
Full resident address of applicant(num r and street.city state and ZIP code) -1
10 i sW ki-,2-
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day year)
jAddress 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.