HomeMy WebLinkAboutMortgage_Shoulders STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
,,,'• State Form 43709(R14/1-20) Gibson Patoka Twnsp 2022
Prescribed by Department of Local Government Finance
INSTRUCTIONS: To be filed in person or by mail,
El County Auditor
Must be Med or postmarked with the County Auditor 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 am first due and payable. 0 County Recorder
See reverse side for additional instructions and qualifications.
Applicard(owner or contract buyer-see restrictions on reverse side)
William J and Lynn K Shoulders
Taxing District Key number/legal description Record number Page!unbar
027 26-12-09-301-001.867-027 cp if2 a-. .. .P.3 si
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appbcant the sole
assessment date,currant year assessment data,currant year date c4addlicebron -a legal or equitable owner?
* ,,ve-oci KI Yes ID hi0
If no,what is his/her exact share of interest? If owned with someone other than spouse.indicate with whom
If name on record is different than that of applicant.indicate below: litilthe property in question:Annually Assessed
Real Property
El Annualy Assessed
IC 6-1.1-7)
Name of mortgagee or contract seller
FIL
0-or g 5 0 ile 7iu.e-leil-,5- viLl drevrt-1-ti ft l P Yk...
Address of mortgagee or contract seller(number sr-.-•—• --,h• •-•-•••• -•••••.',...---‘,,
JAN 2 1 202? 7,y/
Name of assignee or other MAIM or holder of more
Address of assignee(number and street Ciir state D raWer NOC:QQ:2 ' 'i Vh.e.GelitZel a
GIBSON COUNTY AUDITOR
Does appicant own property in any if yes,what No Card NO eduction been requested If yes,date amount of deduction
Dyes
other county
c-.723 8 Ox El
in Indiana? CgiYes RKE No
A person is not entitled to this deductio n urge— ...___... _ . _. _____._..... , _ e 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 rec—ii-n;e7rs'office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Senr "a. 1Z- 6 f it,Ai County
,1"-I Date(month,der year)
k/.31/
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.
Signature(owner's. , ) „...j/9 .., ,
7, Date prronth,day.year)
la t e/.. -0&:4:-vi l'-.20-2-1)2-Z------
Full reeMent oddness of ( _ andsinset,cilr stela.and ZII:code) z
/1519•Z ..e.,.:5-4- ze,'/C,-)1:2 a/ 6 i-/ A in Ce?fe 14 ...:27/ , 2 z_5
Person authorized by duly assailed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day.year)
Address of authorized person (number and street city.data,and ZIP code)
The penalties for penury can include imprisonment u p to two and a half years and a fine not to exceed 510,000.