HomeMy WebLinkAboutMortgage_Kasten STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS — County I Township Year 1
lAl4lit FOR DEDUCTION FROM ASSESSED VALUATION 1 r‘ ,
..t; State Form 43709(R14/1-20) Gibson kirtv\u4-0,A 2020
•:.':it-.1i,„„L:-..// Prescribed by Department of Local Government Finance , I
File Mark
INSTRUCTIONS: To be filed in person or by mail.
is
located on or before January 5 of the calendar year in which the property taxes are first due and payable. 111 County Recorder
See reverse side for additional instructions and qualifications.
rApplicant(owner or con act buyer-see resyrictions on reverse side)
/ftocirew ,/ . e-r7
i Taxing District s Key number/legal description Record number Page number
/ -0-7-301/- 00/ 883-oal Y oco t S*-9-3
rAssessed value of real property as of Mortgage i Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or eguilable owner?
I -1.51t COO IIN'Y'es ri No
ii-no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom ---,
if name on record is different than that of applicant,indicate below, Is thf„property in guesfion,Annually Assessed
arReal Property ri Annually Assessed
- Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
A ccee+ ct Home /1464-A-5_0,0te
Address of mortgagee or contract seller(number and street.cit7."state.and ZIP coWe
-
Name of assignee or other owner or holder of mortgage DraNYCI- NO 4::: /
,1 .„
ioNfforess a of ss Int r and t. pp to,and ZIP code) ,..5-9 3
Card NO.
Does applicant own property in any If yes.what county? What Taxing mount of deduction
in
11 ne rd icaonuan?ty
EDEC342 21 i current year? t___I oo-J ,.._,••- ,
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's offt (including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
1 COUNTY AUDITOR
"Deductionapplodootirl theCarTutNntlef‘:
20 20 20 20 20 20 20
L . 1 _
I Signature of County Au itor A.. ...„, County •I 1 Date(month,day.year)
47- 6 , ,0,-,t,r,
I/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
owner/contract buyer of the aforementioned property on date application is filed.
_
\.S,gnature(owner's full name) -Date(month,day year)
L izr_. 2 ,,,,-/ geiZE..;5--— _ a—/q—24
Full resident address- ,applicant(number arid street city state.and ZIP code)
7/g S 0 Ci th f'i Oat'k s f/we-fr, Prince f 0 4, 27-4,714144 4/Te 70
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0 7 ' Date(month,day year)
Address of authorized person (number and street.city state.and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 510,000.