HomeMy WebLinkAboutMortgage_Edwards (6) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County i Township I Ye
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,41"inp FOR DEDUCTION FROM ASSESSED VALUATION 1 1 -----;
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tj:.^11442;, :•/ SLae Form 43709(R14/1-20) Gibson I 6,,,ifey- 1 cp i 1
-.:::;---• ,.•-•-• Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail.
sought.
k; 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. Li County Recorder 1
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See reverse side for additional instructions and qualifications_
7,-er,pplicant(di;trner or contract buyer-see restrictions on reverse side)--Kee/4Z ii- - ,tellAiati-47S 1
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i Recor 'ler j'-Fag 0 -e-rg'
Taxinn Dsirct- rrn Key number r legal description
.e171 q---e C-- i acc--t., -ti- 470- oot ..s.c)5--oo ,-/ 1 ,
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Assessed value of real property as of 1\.;sosrX-sgr,eern.Co art,t,jiored.rtVness unpaid as ot i yo:tgoarrtept,iproartitarar,ot indebtedness unpaid as of :.esgtha,Foar,opTrbant the:S-d-fs:----i
assessment date,current year r tA,ar date equitable oarier? I
30 )60C2*
rsIL: No
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; If-,;11e.what is l-TS71tier exact share of interest? 'If owned witn someone other than spouse.indicate with whom
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Ifenarre on ..e.ObTd is different than that of applicant,indicate beloar Is the property in question,Annually Assessed
! i[)-Real Property D Annually Assessed
_ 1 Mobile Home(IC 6-1.1-7)
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Name of mortgagee or contr.Tt seller
G_e_r___- ALArx_. _ /9-Al er'cc.c'
Ad-iress of mortgagee or contract seller(sarst,ter and street.city state,and ZIP F III ,
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1 Naa:aOr assigneig-O7-ether wager or holder of mortgage
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AJ:4 „.„77,-- of assib-r,CO(diuroter aild street.city.state and ZIP code)
DEC 2 9 2021
Does applicant oar property .._.
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, in fi,y, I'yes what county? I iAq-iat.Taxing District" _
I Has this dedubtion been requested If yes,state an' urt of dederction
!other county LA.------,Y,, !on property for I
!in Indiana? es e-No , 1 current ye IT1ar? Yes
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A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract itGESS04110111N/TYeAUCtitTOIF(7e county
recorder's office(including any home equity fine of credit that is recorded in the county recorder's office)that is the basis for the deduction.
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- COUNTY AUDITOR ----.
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!Deduction approved in the a mount of
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1 20 l 20 1 20 1 20 ---
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Signature of County Auditor
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Date(month.day year)
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I I\Ne 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
owner I contract buyer of the aforementioned property on date application is filed.
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rS:g;e1:ore co,v,,:37-7s76T,name) Date(month day year)
.1_,...Qt ..,..1:20...4.A...Ze,,,,j12.-- 11*-17,6k(-2,07-1
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TZT resident adnIreles applicant(number end,street city state and Ziff,code) - ,
LA'50 Z. FW1C-)Se-irOPIKJ-j_41kild-q---__,
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Person authorized by duly executed Power of Attorney or by IC 6-1. -12-0 7 Date(rsonth,day year)
AddressoTauthorized person (number and street,city state.and ZIP code;r
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The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.
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