HomeMy WebLinkAboutMortgage_Maikranz (4) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count ' Township i Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R14/1-20) Gibson
,-;.... F-)-, Bra,,,d, I 2020
Prescribed by Department of Local Government Finance I
File Mark
INSTRUCTIONS To be fled in person or by mail. /
deduction is sought. ree", County Auditor I
Must be filed or postmarked 4th the County Auditor or County Recorder of the county where the property is
located o 7 orb fore Janua 5 of the calendar year in which the property taxes are first due and payable. El County Recorder
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See reve se side for adr ions! n t n and qualifications_
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7:1,p-d;;C, , r Vt• tr Y•uyer-see rest rations en reverse side)— ------------ !
Mo:k V-sco..!n_z_____
"Farina astrict Key number I legal descriptio: 1 Record number I Page,number
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Pi- . gia",,k , Dco-let_Itt- 103- 000. q -27- oa (,, I
A5SeSSe,...Yafne o'real procerty as of Mortgage I Co:tract indebtedness unpaid as of I Mortgage/Contract indebtedness unpa'd as of Is the applicant the SeTe .
assessment date.current year assessment date current year I date of application legal ix equitable owner? I
s• No
t) D< El
If r o what is h:s I her exact share of interest? 1 If owned v.itni someone other than spouse.indicate wIth whom
i 1 1
'If name on record is differect tna:that of applicant,indicate.beloy Is the property in question.Annually Assessed
[1y4-eat Property [Ti Annually Assessed
_ Mobile Home(IC 6-1.1-7)
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Na. e o'Mortgagee or contract seller __
Address of mortgacee or contract seller(number and street.city state.and 2IP ceeei--- --------- ----
Name Of assignee or other owner or hold of mortgage
--4.00Q J DEC 2 7 2021 /
Ti+II, J.,I7s of assignee(nornbc_.r and s!re-)et.Cit5'.state and ZIP cede)) Drawer NO — 1
abeaapplicant own property is any If yes whatcotty-fIr -- re.quest ,iaV6Zcattl‘tifin -----1
.e_ 6, rs e.tur__I Fitn r t ca jn DITIM3 ON COUNTY AUDITOR
other count)/ c—,,„ a rd N 0. , ,
in Indiana? Lei f es L441(40 i
A person is not entitled to this deduction unless the person ., ,_._.—„s„ yage or contract 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 the basis for the deduction.
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COUNTY AUDITOR ---.
Deduction ater;in the amount of -----1
20 20
I 20
;
I
I 20 20
20 iii,
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i 20
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SZ. etj.jiie yir r),,iiity Auditor 1County , Date(month day year) — I
/ _._..__Id. .-7 1 6. 6 50/-1 / - 7—
_ _ _
1!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 I
owner 1 contract buyer of the aforementioned property on date application is filed. I
• Sritiiiiiit (owrier.:s fuli itacj _ Date(month day year)
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—P5i.rasent.a Mu
rdees of applicant mbenand street city e a ZIP code
90 s" ,z nd
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Person authorized by du y executed Power of At,orney or by IC 6-1.1-12-C 7 Date(month day year)
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Address of authorized person (number and street,city state,and ZIP code) ------
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The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 510,000.