HomeMy WebLinkAboutMortgage_Graham (5) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS --bounty i Township -I-- Year
FOR DEDUCTION FROM ASSESSED VALUATION _
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State Form 43709(R14/1-231 Gibson I 0 2-7 12-0 a 2i
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Prescribed bij Department of Local Government Finance i
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File Mark
INSTRUCTIONS To be filed in person or by mail.
Form fite.d1-1,.vith
Fillna Date Form must be completed and dated ir2 the calendar year for which the deduction is sought
COunty Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is
located on or be-fore January 5 of the calendar year in tehich the property taxes are first due and payable. L County Recorder
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See reverse side for additional ins' ctions and qualifications
A,e2 62,-/-"re.
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T.: Ds--c 2 - k ' runcer 1 lege'desr.mpt;on 1 Repord nambe i Pag:-.77-cnber ;---i
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Assessed va'ue o'reet prppe ,,,i as o= !r.tortee-ge.i Dontract in unga ut as ot 1 Modgatge/DoVrect indebtedness u-PeeaaePi Is the ap l' nt tha -
aosessn,e,t dice currem yea' assessment date current yea- 1 date o' _ion lega'me itabIe owner?
•, __, Yes IT No 1
If Tre-YvIe si '
te he f her exact share o=interest? ---- -TT-------------T If OWOadWitasorneuneother tnan spouse.indicate wild whom
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•If raaMeaa redid iSO=ferect Dan Mat of apotbant ind.sate be'ow Is t, .274-inquest'on AnnuaIly Assessed
Rpotc ually Assessed i
o e e(IC 6-1.1:7)1 blrineeo7e-fPTgartee or cont-act seller
(-72r2ae_,
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Afian:111O1.1-InbOrtgactee cr contract Is (rr amt.,-and st-e, ity .Stae.arl':;5i5 cirtdei
Namea=11-aSsTaae.e or other ov.aer or ho'der cf mortgage _______________ ____
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,1-Add-a-ss of 1a-S-S11:51,111aejrt adOct'and street,city.state ace ZIP cc.:inj
AUorron
Does apol,a'eT e'.:7,7p-T7Pe telb"a'ey --.-II yes vhat coucty, I V-Ileat Tpx:r-t-gD7strlct5 7 Has this deduct1on be 7 racuested Fr yes state an)ta,:nt of deduct on
I I on property for .., I bt,trtne cao,u;:y i yea Li
Na 1
1 current year? _ es Ei,,,,o 1 ;
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A person is not entitled to this deduction unless the person has a balance on the person's mortgage or nt of indebtedness that is recorded in the county
recorder's office(including arty home equity fine of credit that is recorded in the county recorder's office tha is the basis for the deduction.
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COUNTY AUDITOR _.....__
--6TeSduction approved in the emetic',of
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20 I 20
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Sign:at:rec.of County Apd,tor !County ate(rb nth da xperj 1
cinQ(A.(kAV)S 1 L ato -2-02,2_ ,
, I vve certify under the penalty of penury that the eve and foregoing information is t u and correct and that the applicant is a re dent of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
S.b,ate-e(owne,'s ft.g.'name) Date(month day year)
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F u''hes de-'aC;_1.r Of applicala ElMbe'a-d street c;ty state a-a'Si- code;
C; 3 t. vo- LI----?k07 Z._ •
Person a_Ithorized by duty executed Power F come"or bi ID 6-, -1 -C 7 1 Date(month day year)
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1 Address of authorized person (number and street.city state and ZIP coCIi.;e---
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The penalties for perjury can include imprisonment up to two and a half yeas and a fine not to exceed S10.000
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RECEIPT FOR FILING STATEMENT OF MORTGAG R CONTRACT INDEBTEDNESS:Name = split-L.:ant !Narn or ' "t
22.4 ae. e ,..
6:241 trict
Date.i ed(rn In -/ y rl(711
!Amount of Indebte ness .
Key number/legal description -----JA N 1 2 1
or ... - - ,51, it.- 000 4 - --Oa 7 Ik,vc,\-,:71.--,
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agnat.. .,..- •f County Audi: /County coo des .22. . . ate(month day year)
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