HomeMy WebLinkAboutMortgage_Hardiman (3) Y r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
,*"`=''' FOR DEDUCTION FROM ASSESSED VALUATION
'"'_. i''`4 State Form 43709(R14 I 1-20) Gibson Patoka Twnsp 2022
u Prescribed by Department of Local Government Finance File Mark
INSTRUCTIONS: To be Bled In person or by mail. Form filed with:
Filing Date: Form must be completed and dated In the calendar year for which the deduction is sought. (21 County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is County Recorder
located on or before January 5 of the calendar year in which the property taxes are first due and payable.
See reverse side for additional Instructions and qualifications. —
Applicant(owner or contract buyer-see restrictions on reverse aide) r` ^��
Ray A(Shelly R HardimanVi+� 'v
Taxing District Key number/legal description "1 rd�nup�Q P`yge,pympar/ ,
Patoka Twnsp 26-05-32-100-004.175-027 _ /'Xf J 'XU e3CiF
Assessed value of real property as of Mortgage i Contract indebtedness unpaid as of MOrgtags/Contract Indebtedrmis- ofL tal6 equitable ant owner?
assessment date,currant year assessment date,currant year date of applies*/ --
Yes ❑No
if no,what is his I her exact share of interest? If owned with someone dth n spouse,indicate with whom
If name on record is different then that of applicant,Indicate below: Is the property in question:Annually Assessed
0 Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of me a is or contract sailer ,r-+
P 1'4/0I,"G5"" Z/';v77-C- .) T�i�-Y2.9G G�,, '�.7/." �+,-..r.,-,-.. -t/
Address of mortgagee or contract seller(number and street,city.state,and ZIP code)
Name of assignee or other owner or holder of mortgage FI ii:i._. EAddress of assignee(nunber and street,city,state,and ZIP code) e
JAN1.?n22
Does applicant own property in any If yes,what county? What Taxing District? Has rpohpisadeduce on Ixea quested It yes,state amount of deduction
lntt tthefts El Yes 14No ounpentyaar? es ,04e
A person is not entitled to this deduction unless the person has a balanceon the person's mortgage or contract lndebtedno ed in the co�+r,�{y f recorder's office(including any home equity line of credit that is recorded In the county recorder's office)that is the basis fo diti V nay AUDITOR
COUNTY AUDITOR '^
Deduction approved In the amount of:
20 1 20 1 20 1 20 [ 20 20 20
Signature of County Auditor County` Date(month,day,year)
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. Date(mdnttydaYt �a�r
Signature(owner's our name) j er Qr e,��` /Il ' '%"`r
Full resident address of applicant(number end street,city,state.,and ZIP c � '��
49C)SC. Al/ 5,7/'1" --"re�"i'1r.� • .',,,-' d el -/cn'C7L t.!' -3>t e.
Person authorized by duly executed Power of Attorney or by IC 6-1.1-1 2-0.7
I Date(month,day,year)
Address of authorized person (number end street,ally,slate,and ZIP code)
The penalties for perjury can include imprisonment up to Iwo and a half years and a tine not to exceed$10,000.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS 7
Name of applicant i Name\off mortgagee or contract) ` seller, �^e / , /f edr 1 Vh Iciv,
Ray A/Sheily R Hardiman `'-e4- Taxing District
G1 L , 4
Date filed(month,day,year) I Amount of Indebtedness
yal/ate I N31/S' S Patoka Twnsp
Key number!legal description
26-05-32-100-004.175-027 Signature
of CountyAuditort County Recorder co y
Atjrfrl" 1// Gibson an I par®(m/ t;I lay,year)
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