HomeMy WebLinkAboutMortgage_Brown (26) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County 1 - Township 1 ' Year
FOR DEDUCTION FROM ASSESSED VALUATION _________,
State Form 43709(R14/1-20) Gibson (70 2020
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Prescribed by Department of Local Government Finance
File Mark
/NSTRUCTiONS: To be filed in person or by mail.
Form Red 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 Cue and payable. El County Recorder
See reverse side for additional instructions and qualifications.
AosTii2ai-AiTe.r . ontract buyer-see restrictions on reverse side)
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Taxing District j R hord numtizr 1 Pagi-.. ..,,cjec.i
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i'i.ssesserl value of real property es of !Mortgage I Contract indebtedness umpajd as of I Mortgage/Contract indebtedness upa)d as of Is the a, lid!----the sole assessment date.current year assessment date current year I date of plih to —.) 0 1,—) legal or able owner?
j !
, Yes E No
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' if ro.what is ha/her exact share of interest? I If owned with meone other,gian spouse.indicate with whom
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1 If name,on record is different than that of applicant.irdicate be!o, I t•e property in question:Annually Assessed —1
Real Propera ilAmnonbtrelliyioAmssee
1 I (sir 61-1.1-7)
_....._..._ _ _____ Tii _
Name of mortgagee or con-act setter kyl
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Add,--Ts-,;.-,-,17O7C,- O--:;03;tract seller(number and streut city stat .and ZIP code) M -
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202 1 =, .
)Does Drawer NO lxg Dstrict? Has this deduction n requested If Oa te amount of ded !
other I on property for I
Yes riLij No
in Ind I current year?
A pen Card NO. ..,-....7./.9.. ......... ,ance on the person's mortgage or c ntr t indebtedness that is recorded in the county
retort ,rded in the county recorder's office that is the basis for the deduction.
COUNTY AUDITOR
.
Deduct on approved in Inc amount of- 7-1
1 20
li 20 I
i gna 20
1 20 i
1 20
. 1
1-1
o btdf 3.,...' ..j.- County \ 1 Date(mon ch.4..., cerl)12-. 2 J
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I/We cert e
ify under the penalty of perjury th and foregoing information i tr and correct and that the applicant is resi ent of Indiana and ,
owner)contract buyer of the aforementioned property on date application is filed.
)CSigina." - Ar r's f7e) ateyea
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!F.,,itrrie4addrrof appli,cJarc,urn.z,and street cIty stat?nt_yroZ cod ile.) .....,
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Person aathodzed by duly executed Power of ttorney r tIC 6-1.1-12-0 7 Date(month,day year)
___ • .
AddreSS-ofaorized person (nornber and street.city State.and ZIP code'
rh..r,..,,, Ittes for penury can include imprisonment up to two and a half years and a fine not to exceed S/0.000