HomeMy WebLinkAboutMortgage_Cooper STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS __County I Township 1 Year -1
411.: 411.; FOR DEDUCTION FROM ASSESSED VALUATION I
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cf,:i4140..1-71,,t.ty State Form 43709(R14/1-20) Gibson i 0 I -2'020--
z7;;----____•::-, Prescribed by Department of Local Government Finance _._ 1
File Mark .
INSTRUCTIONS: To be filed in person or by mail.
Form Red with:
riling Date Form must be completed and dated in the calendar year for which the deduction is sought n
11 Coo ty A udi tor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is K
located on or before January-5 of the calendar year in which the
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I Record number Page nurniae---r-7
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TaXg Distr0 Ktrber/leaajeschption
'.-IS —CS`1..\ Th°2-• LI ViC) —0 2-_N--- r)(M2.-1 1 361 tk 0
Assessed slue or real property as of Mortrdage i Contract indebtedness unpairhdsOf---1 Moo age/Contract indebtedness unpaid as of -1-Is the app in ritthe;;7.
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assessmert date_current yea- assessment date current year ,da f ap) I‘nation legs me itable owner?
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- SI) 000 . es El No
If r-TOvitt is ha!her exact share of interest? I If owned with.orreona-01iner t3.an spouse.indicate with whom
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i If name on record is different than that of applicant,indicate bete,: I t'-property in question:Annually Assessed i
F IL-E eal Property El Annually Assessed
Mobile Home(IC 1-7)
1 Name of fr . ,egree,or contract sel;er
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F.,E:ddrzss of mort• acee or ntract seller("lumber •,street.city state,and ZIP code) DEC 1 5 2021
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Addr...as,;ii . GIBSON COUNTY AUDITOR
Drawer NO. 0 1_ ,strict? l Has thisTileCKTptie, tai- r7 requested 1 If yes,state amount of deduction
Does applica
other county , on property for ,.-AY
iin Indiana? current year? l__ Yes Ell No
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A person is i Card NO. 5 9 /la _
on the person's mortgage or c -it t indebtedness that is recorded in the county
recorder's oi n the county recorder's office) that is the basis for the deduction.
L.L.JUNTY AUDITOR
HiledadOtion apprdiYe.dIni7(he amount of ----1
20— 1 t • -- i 1 20L ...
20 I 20
20 i 20 i 20 _....
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•. 1 i
1 i
Date(month day....,42, ) A
I i VVe certify under the penalty of pert i t the above and foregoing informabor true and correct and that the applicant is reside of Indiana and
owner/contract bu e of e aforementioned property on date application is filed.
71.
X rS,aate(Owner'sDate(month day year)
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resTar---,--;: ross of apelicant(number a,d se city sfeth old code)
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Pz;; -7bthorized by duly executed Power of Attorney or by IC 6-1.1-12-C 7 Date(month,day year) •--1
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Address of authonzeJ person (number and sheet.city state and ZIP code)
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—• .-•yra-r„,,.,-,anh,r,man include imprisonment up to two and a half years and a fine not to exceed S/0.000