HomeMy WebLinkAboutMortgage_Dunn (10) s---,j:,•.-f-- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
County __I Township
j.,_ Year
FOR DEDUCTION FROM ASSESSED VALUATION ___
i Sts'e Face 43709(R14/1-20) Gibson 1 7140/4 TN??
.-- .- PrescOlsed bi Department of Local Governn‘,ent Finance
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mISTRUCTIONS• To be filed in person or by rneIl File Mark
VorraTa-awIth ..
riling Date Form must be completed and dated in the care.nd.a-year for which the deduction is sought
1 t"--Ir-L_I CC07.1nntlyY AFZueda;calardr,,,
Must be filed or postmarked with the County Auclitc.,,or County Recorder of the county where the property is
located on or before January 5 cf the caJecder yee-in v.hic1J the p•operty taxes are first doe end pa/able
,Se reverse side for-additionaI instructions and quetifica!I:WIS.
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App',.ant(csas or ca r s.ras: _ya -- ..-a.,- ..... .- ...., .., ...., ___.
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aSe55—..-:-.r,dP,..-2. CL:7,-E-,t ea' assessment date curest;•ea- !date C appllsatIcs I legaf or equitable o., -7
iDi E. . 1 1_,_.___pees [----:No
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'If raTv7eas`.is h S 1 he•axest shase o inte-es12 1 If G...,1,7i v.its someone other tHe-i spouse iads,,,ate a,-;,),,,..,•ft,s, ------
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if-a S-Seads recsesiisd,farest Das 6-itl.of ass'•cast ir-S•zee he0.... --- 1 tathe arope-ty is.q,est'os kr•.O,iii;.!TYAssessed
i '-'1., , 5a'Property Ej Annue'ly Assessed
• r.lobUeHome(IC 6-1.1-7)II
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:.,ii..da-al;/,-;;--r-,,o.,i'i 0-3:7:c-c o r-1 t,-a-:).sA6ler(a sredre-a ed creel cs,,/ stale.a,is'ZiP cciee',
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--s-S..g--;-Fi.Je o-ohel.-7-oe.,,er o•hofde-cf rm.:gage
FEB 7 2022
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-bdes-asp'uTa•STaSe prapc,t/is as,, l'yes v.-as!coset. ,..,l V. Ta,'^a D Sf)sI5 -7-leiaa ths decladt,srIbeen
',en property fa, ,•••••,,,,,,••• B 0 6 d A 1-f A 0511-
9,7,-ca ;;, r yes rt...N.,,,_ i 1 cosamt yeas7 1,4,665 __ No
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A person is not entitled to this deduction unless the person has a ba'ance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home. equity line cf credit that is recorded in the county recorder's office)that is the basis for the deduct on
COUNTY AUDITOR ,..._
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20 20 _ 20 , 2C 20 I
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_PA,N., -
Date(rr-adTh day
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I I Vie cert•fy under tne penalty of perjury that the above and foregoing informal on is true and correct and fret the appl'cant is a resHdent oF Ind ana and 1
o.yrier/contract buyer cf the afore, entioned property on date aopl•cation is filed
S ca',o-e.Is,- fall arra.; . .Dsts fessets ria;., y--,a-
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..=.:,'.•?..t-...,-e--,s. r.(rus-Mes see!slreel afy sla!', aes:27;-3- 1,El
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F2-S-7;:s a_Pecazss by:...iL,,,,ex,...--...f,-:.'Pc, 'of At-to-see,sr by-1,3 6 , 1-12-C 7 Date(r,,,th day yea-,
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-Astiiiiii..-se or astecr,zed perssr fredrber aid s,'.se.e.t.cs',), sfale asi iiocare
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The p,alt,es for perjury can include imprisonment up to trio ard a Oaf yea-s and a fine not to exceed 510.000