HomeMy WebLinkAboutMortgage_Dean -,.. ..-. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS — Count I Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION _.....
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State Form 43709(R14/1-20) Gibson 0 2, -L___ 2020
..:;:-._. ....,:' Prescribed by Department of Local Government Finance L
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File Mark
INSTRUCTIONS: To be filed in person or by mail.
Form filed with.
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought.
County Auditor I
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 due and payable. LTD County Recorder i
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See reverse side for additional instructions and qualifications.
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1,1\op; (evne,L.,.. dclitrzt;Wrywie-s restri lion: reverse side)
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..____.;Taxi li no St y.rict ' Ke nu leg mber/le ' esoription •— number Pa?rmber
As s se-value a real propeni;as,of i Mortgage/Contract indebtedness unpaid as ot Mortgage/Contract indebtedness unpaid as of Is the applicant the sole --i;
assessment date current yea- assessment date current yea- date of application legal o(eVtable owner? 1
!. ..Yes [11:1 No
If rot is his/her exact share of interest? If owned with someone other than spouse indicate v.ith whom
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rIt name on record is different than that of applicant.indicate boo.', s ie property in question:Annually Assessed
eat Property L-1 Annually Assessed
-- ..3ile Home(IC 6-1.1-7),
Name of mortgagee or conyt7 sellec ii...ci `s•---k--,1 -al-A km), GA-"-ICE./-1
Address of mortgagee or contract sells,Inurther and sae ity ." e,and ZIP one
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rairsalaiihrTaiofaassignee or other owner or holder of mortgage 0(2/---05-769? ° -- ' -- --
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Address of assignee(number and..V.,...t.,.city,state and ZIP ccide.) _ ---
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0=7 _ .r Does applicant own property in any .yes what county'? I vi..ihat i-i-',-g--67j,rio(5---aial-Has this deduct; n en requested If yes,state arric),Int of duct, >-
other county
I I on property for
Lin Indiana? F1 Yes - io
current year? Yes 0 No Cqi
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A person is not entitled to this deduction unless the person has a balance on the person's mortgage o cm ract indebtedness that is recorded ' hec--cbity 0
recorder's office(including any home equity line of credit that is recorded in the county recorder's offi e)th is the basis for the deduction. I t=i)
COUNTY AUDITOR
'Deduction approved in Inc amount of co
ETD
20 T20
1 20 i 20 I 0 I 20 I 20
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ear _J
Eia§7inrriaafi;: 'C;nt. AUditiOT I County Date(mom;7 day y )
5 .1 ,
.417,5-... "I I e certify under the penalty of perjury that the above and flaing information is true n correct and that the applicant is a resident of Indiana and
er/contract buyer of the aforementioned property on date ..•lication is filed,
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i S, . Th' I Date.(month.day year)
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ull resident address of applican;(hum .end sIreet ray Vat: and ZIP d-..:,')V7 ,..5z4.1.62„. et 517L ---.47-- 1/74,,,it>5—
Person aathorizeitlitsy duly executed Power.of Attorney or by IC/6- 1 Date(month,day year) _
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Address of authorized personairTiaimher and street.city slate.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$10.000.
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