HomeMy WebLinkAboutMortgage_Dewig (9) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township i Year—7
FOR DEDUCTION FROM ASSESSED VALUATION —_
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ciittilit I/ State Form 43709(R14/1-20) Gibson 1 Wu/S*0-4f 1 ..900,9 I
--!••••-_, :•• Prescribed by Department of Local Government
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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 property taxes are first due and payable. L_____1 E 1 County Recorder_
See reverse side.for additional instructions and qualifications.
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Key number i legal descrIption I Record number .
i Page nunnoer i
D(03
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,..4 ue cr real property as cr ,I.lortgage I Cont-en. incer.ecness uncar,ae o• 1 r..o.tgags/Contract indebtedness unpad as of Is the asp Cart the se;:.---7
assess,ert date..current yea i assessment date current year date or eopfcation
......r 0 ,....... legal ot-equitable owner?
E Yes El No
1Fr:707 what is h.st her exact share of intemst? ,'IT owned with.someone other than spouse,indicate w•th whom
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If name on recorcFISdifferent bran that of sod cast sit sale belt), 1 Is th,property in questlom Annually Assessed
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Y,,F7, a!Property E.,Annually A:.;sessecl
i Mobile Home(IC 6-1.1-7)1
fCaro-eO` ni-dagee cr core-act seller i
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Address of mortgetlee ot contract s-_,..!et(r,rate.r artd s:teel.cif/ ,-tam.t.and ZIP OC-clei- ----
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• 1...is-ira a:E0'assIgnee or other owner or holder of mortgage ------- -----
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7,-,-A7.7aTi-7,-,ss:- --6-7f ass727,r-7,,,(odroLor and sreet,cit,.stale. and ZIP corr.o) jtcNI
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sespplica-1 o.:T.r7Property in any I I;yes ,hat county', I trial Ta ,ng astrict? !Has this cr..edu t. n been reque.s.ted I I'yes state ,T,CY,I,i,of deduct air -1
other county I I on proper,y for - _ ._ r----,„,, -,.,
in Irdaria? Ei Yes [..11 No / , I current NO-1
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
recorders office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
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COUNTY AUDITOR
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DeductionapprOjredinthe amount ct ---------g
20 20 i 20 20 ._ i 20 ,
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' S:gnature or County Auchtor I County ate(month clay yaar)
I! e certify under the penalty of perjury that the above a d foreg ing information is true and correct and that the applicant is a resident of Indiana and i
owner!contract buyer of the aforementioned property on date application is filed. \
S ott,ature Mw•c•-t-'s Tug name) Date(month day year)
'ill'1,7-res r:1,,.:arletre-ss-of ritt-ciicant(nonnber an-slrec; cry state and ZIP croa),-; .•
40 r:cz-5:1- c..., i k,5 on S'-f-,--.-e„e„--/- 1-10_,E,,h s± 1 10 , 4.-/' 7 3 q .
Parson aothcraze.el by duly executed Power of Attorney Or bj IC 6-1 1-12-C 7 :Date(rnenth day year;
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Address of authoitize.d.person (number end sreet.city stale.and ZIP code, 1
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10.000
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RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of epplca,t t Name of mortgagee or contract seller
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Date filed(Trorth ea/ year) A' mount of Indebtedness
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Key number;legal description_ _ —
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DG- 1°1 *31-30frOOD 063 .---00C(
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S'grature of County Auditor/County,Recorder l County ,Date(month.day year •••CYDC1 .
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