HomeMy WebLinkAboutMortgage_McCray i..,. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Township
FOR DEDUCTION FROM ASSESSED VALUATION _____
---Count y I
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: 1 Year 1
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\!'lititiot:7 S. .a,Form 43709(R14/1-20) I Gibson 1 0 2 2 1 2,0 22_1
._,,..._.._. :...• Prescribed b/Department of Local Government Finance
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File Mark
iNSTRUCTIONS: To be fled in person or by mall,
Form fed arm — I
Find Dale Form must be completed and dated in the calenda-year for which the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is , County Auditor
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tocafed on or be.f0"e,January 5 c-the calendar year in v.,hieh the pmpedy taxes are first due and payable , Coonty Fr, -- - ,.-
See reverse s,de for additional instructions and quatificatio,ns
ir;?'': ,ia`7 tr t ,.-j',,,,:tha.rest.0"13 Cr-reveass.side)
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! Key nimber;1---a desed.pt a-.
ok4 21 Lt - 0 Reepre h,ante-
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rat,'pro;rart; as.c.' t., -.ace,;Comaaet tncenteenees a-ma ra as cl I Menrgae Cert.-at,',r-es'el-ess LI-7,71a d as 0, 1 Is 1i".,a:,p;...-3,t t',..A.,.....,
assass-aer;date.co-rart year - ses •rler-lt.date V.. rrent yea- ad he or 6e-ea . I lega'or it.ald.'e ry.,rad-?
CAAir% OICY
' . CifitY0
I Yes E NO
If ro whr-;;Tra--t---laTti-lea exaet sha-e o'ints-est? -- I If owned.v.itn so, ne othea than s-ouse e.e.v
'In I I tn properly;I,qusest'nea'Iy Assessed
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FILE'D ,,, . Real Property LI Ar,..inovia,,Illyi Asse,sisce6d_i.1_7,i
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42QC)a 0 , L
D rawer NO—. • .... .....
513(4 ZiP cc-;_-J--- —-JAN----2-6-2-022
Card NO. .
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.. GIBSON_copt4Ty"pDITOR
--,r-.-d-ser----ellaS-0;-I- e-r--c- -(7:ar -ds's oct ca, state and ZIP cc Or)
Dc.-,aa a00 -,a-;-`70,-fa'add-r;.-IT,2:;-'; II'ye." V.'iat co,,,y") -r .7,1a..i- :;;-1Tg D steer, - Has th'-a'-cle-aceTO- P-- n rebooted -1-r y.,.., state a-coont of dedcet:ono - -------I
Othe-COL.ri r._
No Fr o r;a,r,o r r Yes FI No 1 i
in Ili,a-a? FT Yes L 1 _ _ __ or, _
A person is not entiti,od to this deduction unless the person has a baance on the person's mortgage or c nt ic't 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 tha is the basis for the deduction.
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COUNTY AUDITOR
iar,;':.T.:t.,),aeprdvadrnthe err-Cr-en':C.T. "--1
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20 i 20 20 20 20
i i 20 ! 20 _
---1,C,-n-atgre of Cod-C;Add'tor -- Co...nty 1 Date(r, nit da
1,Vie certfy under the penalt ijury that thle above and foregoing informal on is tr and correct and that the apptcant s a resi ent of Indiana and
owner I contract buyer of the aforementioned property on date appi cation is filed
Si,--- _ire(0,-,,,,es fa,rar,1.9) Date(mdrrth day ye-ar)
,,..,...,,,,,,-ess of apcli n;(rumdc- ad Slree! oty slate end Z/r,cede
)( 5-02, ___s Cl at ct
Rerr-sen a_etechzed by ds'y axe-au:et:. ca.e-of Arearrey or by IC 6-1 1-12-C 7 I Date(moot!, day yga.",
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A..t.-,..s5 of-a-ute-dnzed.person-(-/e7;mber end s!raet oly state amd ZIP d_-,dd
The p,-naltie=fcr perjury can include imprisonment up to two and a half yeas and a f7ne not to exceed 510.000
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