HomeMy WebLinkAboutMortgage_Roth (2) _.,..,
---i--- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ' County 1 . ,Township
Mi-:4k,44:t; FOR DEDUCTION FROM ASSESSED VALUATION _ 1 Year
i We.6kinljon , i
igfrzku,f:„• Sate FearGibson
i 43709(R14/1-23) 1 oa I
Prescribed bi Department of Local Government Finance L.__ i
File Mark
/NS TRUCTIONS: To be fed in person or by mall.
FcticIl IS.dwith' —---.
piling Data Form/mist be completed and dated in the catend.e-year for which the deduction is sought !
Must be,filed or postniarked with the County Auditor or County Recorder of the county where the property is County Audit°,
located on or before January 5 or tnfD ca/enda,year in,...11/i-,11 the protz,erty taxes are first due and payable ! , County Recorder
se--reverse side.for additions!instructions and euatfications
_
-Ap:nIft-,an:tc.i.rier or coez:b,,,,--see restaioi:oos co reveass
1 -' RA:cs• Ist, i STI,;77 •
Ali 061/ist 45t91 06../62% 00 .-.7 tot
A,,,,,,—;s'a•333n3 c,"vle33-,e'c17 ., as C.' t.'ortosioe.3 Cont-ant 131,331-333C3•3333,33es anpe 3:3 ee z' 1<-1D-3:gage./C3,3333ntrant 1••-en13-33:31-ce's unpa C3 ass 0' 1 133 11,•=3 aoi.o1,_.-r-7,...,.SO
...,„.
aSSeSS-3F-3r1de.e.cncen3 yea' aSsessmen1 date curremiiea- 1 date a'aponne1•0,1 I lega'0"eqa-ita.bYte3-0,33- ? '
1
it10/S-OC?, i'''I ,
: I Eld,.."41 * ET No
if r i.:iiii-E is ha,h.,-ex.st1Saa-e-0'int-33,3<s1-, IV c.iiii,ed s-,I.iiiiIIS-;7,7:..-one.°the-C-e-n spouse ind-cate a.Th whorl ---7
. 1
If na-e Cr re.CO'c is C ,ere 3 te,n t a,c•<3,, -a sac, sacs --_o.. I Is tne prope-ti in ques1'0333 Isnrca11y ASS-aSse71--
. 1 yes?Property [I]Annually Assessed
MobIle Horne(IC 6-1.1-7)
• NI-.ISTIiiiie o'ri--IiiiIii- eie .-i,-I---a,m-act-S-e':e- _____.____
iktl_.
FTLi...
Hazt-ain G. ( 044-) •
J2022 or
Kaitlyn Roth-$ 110,500 vi '
• D r a w e r N 0 ( C)("9 I
_,...-eop can:033-p"Ope-3;33,i:--ary !dateay:t;;Jocrt.7---ly.e,seen re7'"ri-js‘.er,Ido 1 GiliSON COUNTY AUDITOR
-----"I
Qv-K.,-cour,:i ..-- -
,,, _ r. .,,----- ,
;in 17d'ana, 1..„.i 1ee 4,-,
_...._
A person is not entitled to this ch,- Card NO. tge or contract indebtedness that is recorded in the county
recorder's office(Including any 1 3 office)that is the basis for the deduction.
_______ ______
COUNTY AUDITOR
---------
Dedeet,on aop-ovea;ir Cce seTdrdtif o7
- _
20 , 20 _ I 20 23 20 : 20 , 20
I .
I , i
S:c3nat-ne of Cc_rity.4,1 ,t , Co.-Cy I Date(nrnndt day yedn
' /
7'''''''' ' , 'ar_
6 /V 50,1 I 1/ay
_ a 1
/..., _
_ _
I i ce . ur- h enaIii at perjury that the above and foregoing information is true and correct and that the appl:cant is a resident of Ind -ana and i
....ineir/ oi tr., •Uy'j of tA," -aforementioned property on date asp!cation is filed.
— „, ,4s:re.! c•;7-„, .s;.2!.,. ono`Z,313,3 cnOs,
v 0 g-- 6C) FC`O.VIC SC a -=-A/ 4/7 6 Y9 .
p,..,--,,,,,,b,,,clu!si exe.:.,Ied Pc,e-otiAtto-r-ei,c,b./IC 6-11-12-C 7
Airtii4r.ss Ofai...,tI-cze.:t.perspr (ranter and sI,eet.coy states end Ze.code
the penett;e,for perjury can include imprisonment up to two and a half yeas and a fine not to exceed 5/0.000