HomeMy WebLinkAboutMortgage_Dawson (5) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS --a- County 1 Township ji
Year
t. FOR DEDUCTION FROM ASSESSED VALUATION i 1
v•IISttit'ii.. , ,1) State Form 43709(R14/1-20) F IL Gibson 2°2
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-...„-- .., Prescribed by Department of Local
Form filed with,
Filing Date Form tcrtrist be completed and dated in the calendar year for which the deduction is soi.wht.
County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the DEiey,Zrhere2en o is
located on or before January 5 of the calendar year in which the property taxes are first due and payable. L...J County Recorder
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see reverse side for additional instructions and qualifications. `-12,,-4..,,e cz
i Applice nt(owner or c‘on...t[act buyer-see restrictions cn revere:e.STdet) ----GIBSTYWC 0 U N T Y AUDITOR ._..._.
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7, ng D,stric,t Key number/lerza!description Ibecord number 1- e Pag-numbe
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Assessed value of real property as of Mortgage i Contract indebtedness unpaid as of 1 Mortgage/Contract inde.htedness unpaid,as of Is the applicant the sote .
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'assessment date current year assessment date current year idate of application lege'or equitable owner?
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' P ro :;.hiatis his I her exact share of interest? If ovmed with someone other than spouse.indicate with whom i
1 1 1
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rif n-a-r-r-e-Cn record is different than that of applicant,indicate beto, Is the{),,c-at,¢41.rty in question-Annually Assessed
U...kiffcal Property Li Annually Assessed
I Mobile Home(IC 6-1.1-7)1
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Name Of rin-Mirigagee or contract sefier
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Address oinnortgeinee or contract seller(ft bar end street.city state.and ZIP cndei
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Nameof assgneaor other owner or holder of mortgage
D rawer NO I
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TA,Td7. c--. -,c;-- -ssi.,;e:,..(---, ,,-,,----,t,G,-mid street.city state and ZIP code) '
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• Card NO.
Does apPfietant:c7.fm property in.any I'yes what county? What Taxing District? 1 Has this --i
l on propi
InneiTp.`a'r;t•l Dyes [xi No 1 current y,,..i
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or con act--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)tha is the basis for the deduction.
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COUNTY AUDITOR
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DS.rFection apposed in amount of 1
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20 1 20 i 20 20 20, I 20
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Signature of County Auditor ----T-Cojn--- --- Date onth.day year)
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I I We certify under the penalty of perjury that the above a d for mg information is true and the applicant is a resident of Indiana and
i-ner/contra uyer aforementioned property on date ap cation is filed, t
III .rona re owner's fi iime) Date(month day year)
resident address OTagr_'lic.ant(number and street city state. and ZIP code) r, .
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'Person autnorize, y duly executed Powe.r of Attorney or by IC 6).1-12-0 7..., i 1 Date(month,day year)
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Address of authorized persor (number and stiteet.city state.and ZIP code) i
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