HomeMy WebLinkAboutMortgage_Scamman ,.-:,•,-, :.- ,„ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township I Year 1
FOR DEDUCTION FROM ASSESSED VALUATION ___
i
Sale Form 43709(R14/1-2)) Gibson i
1 Ft '3 ckl .90.20 i
CA el 1 i
--f•• ••• Prescribed by Department of Local Government
INSTRUCTIONS To be fed in person or by mail.
Form filed,,ith
piling Date Form must be completed and dated in the calencla,year for which the deduction is sought
_ y
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is Count Auditor
located on or before January 5 of the calendar year in which the properly faxes are first due and payable 1 County Recorder
i
See reverse side for additional instructions and qualifications.
ApTi-a•:;tT(c A ne-c,contract berar-see restrictions or reverse s/de)
,indield AA 'k1 sco_4r__014F,,Ki______________
::6-s:-ot Key rmmbei-/le-g, de-scriptan 1 i Record n,...mbe., Page numbe r;----
F t . 7!‘"" c-0,..--•-0\--, , 0G-18-dg- t:0(.. - °col It e- 0,.)cp i I
Asses-sea value ow al p,-operl,-as c,` It.lartgage i Cont-act in,_.eu.eeness unpa it as o 1 mdr.gage./Cortramt indebted,.e.ss unpa•td,as o, I Is the asp cant the sola..-;-----,
assessment dale cure yea- assessment dale current yea, I dale a'appl.cation I legal ca equitable one-?
/63/ COO .do^
•. 1 14,,PeGs [ No
-If ro v.ihat is ha I he-exacl sham of interest? ,;I'owned st.ilia soneone'eTaTel1Cnan spouse,indicate.v.ith whom
- ,
If name on recoJid is differe^t 0‘ad,that of add,cant indlzate bel-fg-. ;Is the propetty in queslian Annually Assessed -----1
. i F-IIII
. , LC-Real Property El Annually Assessed
i Mobile Home(IC 6-1.1-7)
r-N ame or rrohleacaa or conttact selahar '2___ 0 2 \
RocK + JVo t-rr Drawer NO
----
!Address of marl-gear:a G. curia-act s-elleumber and stmet,nly -
Card NO. ... .V.4.7............
N 3,ra C`assignee or other owser or hoaer c.(no.gaga
JAN 11 2022
_
-,4J.IC2,,.i---(Ti asS,6-,c..,:-,(rdniber sr st.met.city.Se" a,d ZIP coda)
A.clutAi a,J.,a,f„;mtd_ .
. •
--,Does applicant cm.r-pmporty irt any It yea sshat county', 1-3,'.thal Taxing D'-etTict, Has this deduc,t,on been requested .....
;9ther counti r--1 yes rg.›%..0"-1 I i on property for r-.113SCINt°C)illq"Il.
in cc aim' current year? T (6 D No 1
'--:L___
A person is not entitled to this deduction unless the person has a balance on the person Is mortgage or contract 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)that is the basis for the deduction.
COUNTY AUDITOR
___ _
1:7-sTduction aapTteved inthe arr-Tuuhl of .
20 i 20 i 20 i 1 20 j_i_ji l 20 I 20 I 20 i
, I
i L.. .„._. _
Se,of-Coanty A..;ddor County f3-ate(month day.3,3ar) i
'0 kl
1/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. at <II2,---,../Maa's huIt nar,a) Date 0-northi day
'I .42/"-/7—
---_ -
._, ms dent address of apcii,:ant(numeu-and....s:rual c,ty state and ZIP code,
‘11 b C* '41/1(co,C' '' l '-':,7/ 1-41''',V467‘, //t/
Re-stan a.ftror,,wad by duly executed.Power of Attassayerddi IC 6-1 1-12-C 7 I Date(month day yea-1
I
Addtess of authohzed person. (number and stmet,cdy state and ZIP code;
—_.
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10.000