HomeMy WebLinkAboutMortgage_Hardiman (12) s" rs STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS —_____County i Township 1 7 ar ;
7...P,i.-'4•:',..-1, FOR DEDUCTION FROM ASSESSED VALUATION ----,
State Form 43709(R14/1-20) Gibson r-.ice A„„,, aa i
.:-,..._.. .....- Prescribed by Department of Local Government Finance i--
INSTRUCTIONS: To be fled in person or by mail.
un Co ty A uditor
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Must be filed or postmarked with the County Auditc.)r 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, U County Recorder
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See reverse side for additional instructions and qualifications.
- - ._____ _
......_Apoi,cent(owner or contreet buyer-seer _____istrictinns on reverse side)
7:50 it clo Par feirvIztei
faxing District Key number/legal description Recorbri;Iber [Page number ----
. Pr',not-kovl , <20-).1-16,7-3ot -co/. 73 3- 0 D 1
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7-Assessed value or real property as of Mortgage i Contract indeMe:Mess unpaid as or 1 Mortgege./ContraOA-indebtedness unpaid as of Is the applicant the sole
' assessment dye.current year assessment date current year 1 date of application legal or equitable ovens-c
231 —700 , E91'es E No
4
If no what is his I her exact share of interest? If evened with someone other than spouse indicate with whom
1
If name on record is different tn.an that of applicant.indicate belo.i; Is the property in question:Annually Assesse-d-
1 EL.-^1Teal Property Ell Annually Assessed
Mobile Home(IC 6-1.1-7)
, Na7-ii-Te7-r7r7rLTd-gagee or contract seller
pfi,el)_i_--/-iikti,
Adcressof mortgagee or contract seller(cumber and stree FILED.e ,
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TNaTM-e-Or-a-S-sTg-nee Or:et-her owner or holder of mortgage JAN 0 4 __
2022 • _______ ,
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Addeas of aSsg-li rn nee(ndbor and sheet city state and ZIP cod g /
e)
Yheacolzezze a,..4.--4,4464;na) 1
rifiiT—c1-7-;T,) property in any If yes what courOMSON—CiatiztilTaVAIRMITOR 1Has this dedu on Ices equested If yes,state amount on uebuution -
crthercounty Ion property f r
i in Indiana? [1Yes ELK° 1 Lcurrent year ira-Yes E No
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A person is not entitled to this deduction unless the person has a balance on the person's mortgage contr t 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 at is the basis for the deduction,
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COUNTY AUD _ITOR --1
_........_ — _ _.....,
Deduction approved in the amount of -
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20 I 20 1 20 20 ___ i 20 1 20- I
, 20
, 1 I
1 Slgnature of. ounty Auditoia 7 !County& / Date(month.day year) ---
_
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 I contract buyer of the aforementioned property on date application is filed.
onature(owner's,uf,ram- Date )onln day year) -
--__= VSIii FriLtr resiclent address of appl-Lai,it(nu ends:reef drystate and ZIP codek_-- —.......-------. -
(--A._) CX QtVO„\_- ,c\jkk\ c: \,_,.)_Q_ _, m 1 1K-D •=4"-- 91-4---(_Th
pe,s,-,,arizi-i(.1 by duly executed Power of Attorney Or by IC 6-1.1-12.0 7 Date(month.day yawl
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.