HomeMy WebLinkAboutMortgage_Dick (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS — County i Town
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snIP I FOR DEDUCTION FRCIIVI ASSFSSFrl X/Al !IA-rig-1m — Year—
fki3:::., ii- 61a:a Form-43709(R14/1 Gibson I 0 2 ?---. I A 022_1
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INSTRUCTIONS: To be fed in pro D r a vv er NO .2_ 0 1 2 File Mark
Ferm fl'ed with ,
Fri/rig Dale Form imist be camp, i„,"-' ;ought
Must be filed or post
Card NO. i ?91:-') lty where the property is
ai-,7-, County Auditor
located on o,before.. first doe and payable i L.....2 County Reorder
see reverse side for additional instru___
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1 1%,ortgage i Cort,t-ch.1i"-!e'--sidn"ss 33,3,Li 3 Cs-t I 1-..1,c-1e;ja‘ge so,,,,pertj,a,c1i3 ..b'.e3-33. -pa.3 2-.3 o'' 1 is7ii-TF-a.i."3i h-. nit(p.c so on •-!--]-7.;,-------.:—•,:e ct res'propc^t, eh cr.'
assess-eht dre.s. ceder':yea- assessment date curreht yea- !C " ?
OC) I-P..a or ,t...ad!•...o...."-m?
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I Yes Ej',No
If v.Ha`..is h s'Pe-exast shahe et intetes.1? If cy,o3.v.i...",so, ,eone othe than-spouse imdicale-...'th whorn .
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1-6,11--he on record is d ttereht t"a-Met of appLzeht i33.3. 3.e.bee . _ —.. 1 i :•e prope-hy!i"queshon Arinda!!y Assessed i
"I.. roperty Cl Annually Assessed i
• Mobile Horne(IC 6-1.1-7)i
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No-re a'a-SSTg-hreilee-ohm ov.ner or h.o'd -cf mon:gage '0A, 1_49 4-'
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Does acic'ih:a11er.-p-operty ih any I I yes v.hat cochtp ---F-i,.,--Ta'r'r:,7;i-d:-;:; ,------------T-izi- --ii:iT--c-'1,2-17;::o,- ,,requested tis yes state a-oo.,„:of j47.-i-T,T,T --1
!en property for r ., 1 i
F'r.,thhe,'ca c_u_?;''' 1---1 Yes r--i No I i ,current year? . Yes l___i No
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, 1 A person is not entitled to this deduction unless the person has a balance on the person's mortgage or on act 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 offic-)th is the basis for the deduction.
COUNTY AUDITOR
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1Oses:".717...-;".arTorC!;elhhi^the ser--C-ii---1 of
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I,We certify under the penalty of perjury that the above and foregoing informat on is true and correct and that the apol'cant is a cad AoiInd,anaand --i
owner/contract buyer of the aforementioned property on date application is filed.
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vS,c^ re(D.,"er's fisir rra1,
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X Fi.,,! f.s -r.t.at're,33-0%, .mcclicsm(remae-r-ih7t.sass,/ eey s!".-.!ed ZiP c ,.
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,e,by did-,executeks'. c,e-of ri.tomey'Ls'bi IC 6-1 1-1 -C 7 I Date(rec-ite day yes-
Add
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ress ot a,..liti-ohzeo per-ear (cLJrcber e,-,c/sreet c/ty stets and ZIP ccc..--: —1
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The p,.nait;e,s for perjury can include imprisormertt up to t.,..c and a ha/f years and a fine not to exceed S10_000
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RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT BTEDNESS ----
i\i-i.7.- f et=;- et ' ak. N me of mortgagee or . a_
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De/rs.Wed(roor,e CO/7,..la :Amoun, 1,..1C.de.bted-r-e.See Ts,0 no Dff?;r+: -
. -_ ' 5't 14,00
Key numbeea r/l !deri scpt;orCR 0 2 s12-02-<) 1\ %*‘.
- 11_ - . • )Scrat re.of€o' ty Au itor/C\ounty Recorder 'County ,?,......0„.,-...., jka./.12.4{..*;:e3te trrith day len
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