HomeMy WebLinkAboutMortgage_Douglas (8) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS I—County_ I
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FOR DEDUCTION FROM ASSESSED VALUATION _, wnship Year
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State Form 43709(Rid I 1-2D) I Gibson
<-,.... . — Prescribed bj Department of Local Government Finance L___
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INSTRUCTIONS To be fled in person or by mail. FILE :. ,TeTd-\.-•:7;:h —-- ,
Filing Date Form akist be completed and dated in the calenda-year for which the deduction is sought
Muse be filed or postmarked with the County Auditor or County Recorder of the county where the property is O.,,,,Audrto,
located on or before January 5 of the calends-yea.-in v.hiell the p-operty taxes are first due andfAilhie —...! County Recorder
se.,reverse-side for add,tional instructions and queifficadons IV 1 3 2022
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As,„,,-...- ...,..:v.,-..,—:. ;ea'prz,zert r'' 1 f.•-urt,,,age.i Codt-adt !iadetted!-,e.se udbe d es ot data of-appaoet
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atasesdnert d- cz_:,-..eat ye2' i assessment date cd,radt yea-
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If-rIr.. `....',F.'".iS 1-11 :i 1;:-E:;!'a-:7).sha-a ot inta,..ast? --------TiTt!d...........itd so en tt),''..he!!!-baa, spaus -ir,d!r-ate,...'t!-,
cn recafdfadffere-t taa,tt-at of COP _5 no aet.te be'o, ! _ ..p,„,p_4 t.quo,....,n Annaa.ty Assessed -I
l ! Real Property [7.1Annually Assessed
It..loblle Horne(IC 6-1.1-7)
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:!!!!Add,-'ladO'!---0,-tgaaea o-co,ttadt se'Te-(rd-,d-o-add st-aa t city! ,S13e.sod ZIP code";
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0 c-,e s app!!dar.o....-c:ata,^afty I-.a ,y 1 I ),_ idt,od beer requested IPr yes state a-rtad-t of dededt:or I.
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.in lad,a-aa 1! i Yes 11-—I N o 1 r 1--1 Yes ENO
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A person is not entitled to this deducti.: Dr \T r) c2 0 —. ,r contract indebtedness that is recorded in the-county
recorder's office(including any home t to) that is the basis for the deduction.
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D-e--.1,..dt•cd.a:-.7--,-bJad.to the.abbcd^,t of - Card iTN,,_
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,Vie oar-0y under the venalty of perjury that 7-7.ieta'bove and foregoing information i t e and correct and that the appfcant i a rend nit of Inc Lana and
owner/contract buyer of the aforementioned property on date appl.cation is filed
4...., Sf.:^2.- (a.,,,te-ts fli,reale) !Date(roota do;year-) .
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-'. (,7 57 I) . 4-1421) -5 tomi-eiq-5 v;//e- ."/•.) ii7C0,4,,S-
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Fae-aaa a_d.,,af,z-e,!-4:Ida,exeduted Po.,,e-of Aft 0'7 e}0,b i IC 6-1,1-12-C 7
I Date(rrodaa day yea-
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Address of adtt-o!-zed person. Cr-:umber.e,d sateet".cif/ state' add ZIP c7C,E. i 7 ,
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The p,,nalt,!e.for perjury can im.-Jude. imprisonment up to two and a half ye.a-s and a fine not to exceed S/0.000