HomeMy WebLinkAboutMortgage_Hopster (2) ;7.47•* ,;. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS — ,
County i Township 1 Year
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La".414 li. FOR DEDUCTION FROM ASSESSED VALUATION ---
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State Form 43709(R14/1-2)) Gibson 2020
Prescribed by Department of Local Government Finance i
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File Mark
INSTRUCTIONS: To be fled in person or by mail, ,)
Form fled withi
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. E-1 County Recorder
See reverse side for additional instructions and qualifications.
Applicant(ciwisir or2 --Itenarlbuyer-.see restrictions on averse side) -------
11 fl
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rax,„,..,,ct Key number/leoal description .., 1 Record number Rage number
fr-+ rIKh
Assessed yahue Pif real property as of Nalsosra.axe,,'Co cct,,,i,nrednetbt,e0d;ess u paid 05 0, IlilacTrtegoa,gaepr/31,,oantitoranct indebtedness unpaid CS of
assessment date.current year losgura,7caiepc„,uci.ubtiteheo,s,.onieer,
D .' e'C. 1 ITTLPeoS El No
no whais he/her exact share of interest?I
1 If owned witn someone otherihan spouse.indicate with whom li . t
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1--iinEime on record is different linen that of applicant.indica the property in question:Annually Assessed
i !I- I Property LA Annually Assessed
i Mobile Home(IC 6-1.1-7)
Name of morigagee Or COntraCt Seiler ..2G,,R
Drawer NO I
i,if.--ddress of rtca-Fee or contract seller(number arid sta .
T------ EEC 1 r 2021
5---(-( S 3
Card NO.
3,rle ot assignee or other owner or hdder of mortgage
_ _________________
TArlJof-als;l67,eeimirnt..ier'ia-rid s!reet,city,state and ZIP cede)
al.Jia,..1.41.1)
- IBSON OUNTY AUDITOI,
Dc-7.=:;-applica.r'lla.-J,.,property in any v yes vihat county? 1 iAlhat Taxing DStrici-5-- Has thi-a-d--e-d--uctio en requested If yes.state amount o eduction
!other county [ Yes [ii:iicrri I on curproent perty for - I
r year? __. es D No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage r con 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 t e basis for the deduction.
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COUNTY AUDITOR
0.edtitio?1 approseTthe amount of
20 20 20
20 1
, 20 i 20
20
1 1 1
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§;:- 6re of C i nty -ci
. Aar,— Au Ito ,ct 40,4:r ..,,,,cry --TT-bounty Date(month.day ye.ar)
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I 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
owner/contract buyer of the aforementioned property on date application is filed.
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S e.,g,ature(t),YMeTs full name)- Date(month day year)
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' For resrlent address of applicant(rurnbe,and sfreet city state' and ZIP code)
7 c..x. J_V___ X.Q..,t..--, f-:-7: g-f....0.--e- .---- 1;),„
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' Person aothorized by duly executed seer of Attorney or by IC 6-1.1-12-0 7 Date(month.day year) •
•
•Address of authorized person (number end 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 S10,000.