HomeMy WebLinkAboutMortgage_Miskell (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS — County j Township _lYear -1
FOR DEDUCTION FROM ASSESSED VALUATION
'‘.E.I;i•itittoji State Form 43709(R14/1-20) Gibson Certie , - 1 •= e)c:',0 I
Prescribed by Department of Local Government
property is County Auditor
located on or before January 5 of the calendar year in which the property taxes are first due and payable. Li County Recorder
See reverse side for additional instructions and qualifications.
TApp;icant(owner or contract buyer-see restrictions on reverse side) — ,,—
/I/IM+het.t/ 1 R Li CV1 /171 Ske 1 1
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-faxing District Key number/letfal description Record nb y
1 Page number
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Ceil4 er- I , G2 -13-3q—io/-00/., 67 D3 - 06>V 1 I
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Assessed value cif real property as cif Mortgage/Contract indebtedneSs unpaid as of !Mortgage/Contract indebtedness unpaid as of Is the applicant the sofa-
assessment date.current yea- assessment date current year 1 date of application lege'or equitable owner? 1
/3o r,e,
rj- -y 0-s E No
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If co what is his I her exact share of interest? I If owned with someone otherthan spouse.indicate with whom
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If name on record is different titan that of appIicant.indicate below --- — — - I Is the property in que.stioni Annually Assessed
[ill- Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7):
,Name of mortgragee or contract selier
1 "-i) 14 FILE D_
;Address of mortgagee or contract setter(nur7bea and street.city state.and ZIP
_....__. .____________________
Tiva,,,,,ot assignee or other mailer of holder of mortgage JANA-6-2-02a
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...5--( - -----;; ;-&-.,..1%-e7,444;ykd _ ___ __
GIBSON COUNTY AUDITOR 1
i Does app)iC ),Fitriol, ---T Has this deduci-bon been requested If yes state amount of deduction ----I
other count counrler,propertyfor n.„,
S
in Indiana?
year' ,)4,-)tfO L j No_ is _
A person i: w)the person's mortgage or contract indebtedness that is recorded in the county
recorder's L,26,,i 1 _ 7 the county recorder's office)that is the basis for the deduction.
NTY AUDITOR ,
EITe:d.0MMMd;;;
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Signature of C._ unty Auditor --ate. ......._......
County i.,, - ,
Date(month day year)
/62_1. -1
—I 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 j
owner/contract buyer of the afctementioned property on date application is filed.
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„._ _......__Sanctum(owner's ri../P name)
- '7-Date(month day yea()
_ 7tbileee(,' /e _ _._ 1 e 611.s .2.„._ 1
'Full m an
res-pent address of applicant(number and street city state- ic,,nd ZIP code) -----
,- 6"-5"-C) 7"<*///c- 7-5-C. '._,,_...27.1, '''',.›. --c/.9
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'Person aiiithorized by duly executed Power of Attorney or by IC 6-1.1-12-0 7 Date(month.day year)
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•Addressof a uthorized person (number and street city state.and ZIP code; __,
1
The perialtes for perjury can include imprisonment up to two and a half years and a fine not to exceed 510.000.