HomeMy WebLinkAboutMortgage_Deal (11) 1 1y 1 p I Year----1
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS -count _Town shi
74,i14,-ft% FOR DEDUCTION FROM ASSESSED VALUATION 1
I k _ I 2022
•.:,•,, . ,-y,.../ State Form 43709(R14/1-21) Gibson 0 ra Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS To be Tied 1 n person or by me;!
Form 0.e.d with 1
Filing Da C.-, Form(-mist be completed and dated in the calendar year for which the deduction is sought
;-1 i Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is Count Auditor I LI;
located on or before January 5 of the calendar year in which the property
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Tia:nififfTg 0 st-nt Kc...‘„) r__'camber it 'desomation j Resord narritrer I Page nonober - 1
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Assessea vr.-'55 of real prosier:,F.5 C t 1 I.'3 gage i Co indetledness,1-.p,-,-.•....CS; 1%ii-;,::5a-c,77(.I-:07:7t7a-77,, I. ebadss unpa d as of I Is the an i.c. nt the soje -47
assessmerf date corrant yea- assessment date current yea- I date ofi opon ,., t legai or ItabIe crifine?
i L -5G U CD I Yes H No
if MOY •a t -5 h a!hoe exact sha,te of interest? I If G,,ned v.ith s rreons)otzher oan spouse indicate 55itin whom
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if frMcn record is d ffereet ti;:a-F-st of app cant Of sate beio, 1 I Vs propay in question Anin5ally Assessed
1 j _Real Property E Annually Assessed
tioblle Home(IC 6-1.1-7)1
rr4a,e i------Ige:afee„ -io., int seIier
a s c LP _ _ _
i Address 0„,0.,gregee 0,cc,--trat S .-inamber nd t-eet. ity' stafe.acy C.,7.-d.,,
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C`a. g.:, G other di):,oer or hoifer cf rro AN agage
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-1114Oif 1111-ssof IS 15 as ran ea(Tiro'Of,dr ad S'-ee't Ci!, state a nf ZIP cc±st:FO/Mn'7-1:1-iCt.'.-.12/ 7--i- -- — - —
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_ PA:47- ,.0.„
Does app,Iisant Or pr g astrict, '• j Has th:s do/faction o a rjouestef I IL yes state annoant of feduction
other count,/ ;ei,, I on property for I
in Ind ans.)? L 1 YE j current year, 1 Yes [7]No 1
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,
A person is not entiti 'e on the person's mortgage or c ntr -I indebtedness that is recorded in the county
recorder's office(Inc ..2-0 2-...\' fin the county recorder's office) that is the basis for the deduction
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DUNTY AUDITOR
Ca r(1 NO :,&---7 0 41
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ntyl•.O---t-o( - I County Date(r-tonith ay-•fa- '
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, ,We certify under no ena 'perjury that the above and foregoing information i tru and correct and that the appfcan is a r sident of Indiana and
owner/contract buyer of t a orementioned property on date application is filed
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- ' dien-f=a-41f-a--of ancaisarritTefj---17-rer F-.,"," ',.,-,.' - sfate en Z ode'
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Pcrsnii-sea by dia'y exestilte.,-,-,_i-,9r of 2i.O.Orney orb/ID 6,1 1-12-0 7 1 Date(month day year) Lif
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A-mross of authorize:1 oris7sar (rfarn.t.,er and st-et c:!:, state and ZIP cst,de 1
F--eaa,fry p.m;include imprisonment up to two and a half years and a fine not to exceed S/0.000