HomeMy WebLinkAboutMortgage_Robling (3) ---
41,-,. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County i Township -1 Year
_
i.i%!gly FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R14/1-20) Gibson 1,,,J(.)4,•.rt!p'ill 2020 '
Prescribed by Department of Local Government Finance
INSTRUCTIONS' To be hied in person or by mail. /
is
located on or before January 5 of the calendar year in which the property faxes are first due and payable. L.1 County Recorder
See reverse side for additional instructions and qualifications.
•:--ixpp-ilcant(oansr or contract buyer-see restrictions on reverse side) ----
.C,R.C&C.N,-t) (; b I,nci
Taxingbistrot Key number/legal dettcription 1 Record number -I-Page number
15 - tbo- oco. 53?-o 1-7 I ,2,-.-- o„„)1 1 6 ..?o
ey
..._ ,.
Assessed value of real property as of Mortgage;Contract indebtedness unpa'd as of I Mortgage/Contract indebtedness unpaid as of Is the applicant the so'i
assessment date.current year assessment date current year I date of application legal or equitable owner?
/6,-. , ela) i .),,ttm No
If co V.That is he/her exact share of interest? I If owned,itIn ShantiOO-n-eaother than spouse indicate with whom
1 I
If Obrbei on record is dif';'-erent titan that of applicant.indicate bolo., i Is the property in que-stion.Annually Assessedf
11—.-41 Property E Annually Assessed
_
Of -
410P11100 Mobile Home(IC 6-1.1-7)
,
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1-Name moil ee or contract seller
4 FILED
rAddr'Zssof mortgagee or contract seller(number andaTibet --,
Drawer NO.92.0.gd.........
Name of assignee or other owner or holder cf mortgage----- --DEC 1 -5-117121-,./L4/ -1
Card NO. r i
--A d-C i,E,1 of as s a e e(number and sb-ettet,city)state and Zlf 1
ea_a-..44 ,, )
Does---applicant oar property in any If yes what county'? Vi.thatiaxIng D.strict? I Has thIed-I-eJUOt: n en r ., ... , , , eduction
°the-county on property for
in Indiana? n Yes [1:2‹:, j. 1 current year? _ _1YeS [.--A No i
A person is not entitled to this deduction unless the person has a balance on the persons mortgage or n act indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorders office that is the basis for the deduction.
COUNTY AUDITOR
'.--Cieduction aparO...eir-thirie amount of
I
20
\, 20 T
20
20_ 1 20 7
i 20 i
;
i 20 —1
L___ 1
Signature of County Auditor County Date(m onth day year,Cl/r ,(--;
.---
....__ (YL
. 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 onature(owners full ie. Date(month day year)
:„....,./'". i' —/c-------.2 ,2_f
V,Ii7i;7 ent ere-Ss of ap, uant(number er,d strnet c.ty state and ZIP cod.e)
5-z( / K, (?<-- P,,y0-<:, TA._,./. '7'> 4,6, ___„,_______
,person aathorize,d by duly executed Poi. er of Attorney or y IC 6-1.1-12-0 7- Date(month day year)
___________
Address of authorized person (number and sbeet city st_ate,and ZIP codet--
.„......_.
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000