HomeMy WebLinkAboutMortgage_Martin (33) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS — County 1 Township _Year :1
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R14/1-20) Gibson 0 9,k oigai 1
Prescribed by Department of Local Government Finance
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. j 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 due and payable. 1111 County Recorder
See reverse side for additional instructions and qualifications.
___
Applicant(owner Or contract buyer-see restrictions on reverse side)
L_ 4- f ,-.•% . Vnf3.4A-Lifi__
['faxing District Key number/legal description Record number
0 DI • VD 63— 0.Z_I , 2.\ 4---- -
I Assessed val e f real prop rt of Mortgage i Contract indebtedness unpaid as of Mortgage/Contract indebtedness'.'2'Qs of Is the applicant the sole
'assessment e.current year assessment date,current year date of application legal or equitable owner?
''i t—A Lel, 0c)C) . ELprr's Ei N
-If no.what is his/her exact share of interest? If owneciWidbsomeone other than spouse,indicate with whom
if name on record is different than that of applicant,indicate below, Is the city in question:Annually Assessed
Annually Assessed
me(IC 6-1.1-7)
._._.„
Name of mortgagee or contract seller
E(..—,••\) OCL-CVS ._)_IL IL-C._ st>.S.,„,a_O--S)p--42.."---fa-D Q..—%—.\_.LAr'•--:-.:)------
Address of mortgagee or contract seller(nu er and street,city state,and ZIP co e
20
Name of assignee or other owner or holder of mortgage
>zior-e- i 24
GfE
'Address of assign, . .
"Tv A uorro
[-Does applicant cis krneeea, T/6-‘73° R
? — Has this deduction been re uested If yes,state amount of deduction -1
on property for
liont hi ri,e rd icaor,u.n7ty E
current year? es ri No
Arepcoerrdseorn,sisonffoct: .' ol \50( (c, Tectcl-le_c- a person's mortgage or contract indebtedness that is recorded in the county
county recorder's office)that is the basis for the deduction.
::--
QsaiDeduction approv AUDITOR ry I\JO 0 -I
02 20 20 20 — I 20 20 20
I -------
Signature of County Auditor . CounA Date(month,day year)
•(Nr Dr.Th \A '—' •-k:DOC7 -1
! I/We certify under the penalty o perjury that the abov and f ing information is true and correct and that the applicant is a resident of Indiana and
i owner/contract buyer of the aforementioned property on date application is filed.
Sign.ir (owner's,full nag.) maAti...... Date(month,day year)
Xull resident address dfappligant umber and street.city state.and ZIP code) _ —
(- i • i
--1
Person authorized by duly executed Power of Attorney or y IC 6-1,1-12-0 7 Date(month,day year) 1
1 1
---
Address of authorized person (number and street.city state.and ZIP code) i
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.
--. ..