HomeMy WebLinkAboutMortgage_Mayberry (2) _
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS _ ___
County 1 To,,A I
FOR DEDUCTION FROM ASSESSED VALUATION ------
rnship
i Year
voNtriet :-/- State Form 43709(R14/1-2J) 1 L...___ (01,-- L
\::•.;-..... . , Prescribed ty./ rt Depament of Local Government Finance Gibson I 2CDR:
•---......iiitAii---'
File Mark
INSTRUCTIONS: To be fled in person or by marl.
Term fVed,7. _t,
riling Date Form'mist be completed and dated in the calendar year for vthich the deduction is sought
1 r-Z County Auditor
Must be filed or postmarked with the County Audttor or County Recorder of the county where the property is
located on or before January 5 or the cate.nda,year in v.,hieh the p,oi_-.erty taxos are first due and payable 1 L L...2. County Reco-do-
see reverse side for additional instructions and quedifica flans
O!!!;-
Re-ord hdr-lb., I P se rh-o'r-e:
10\- CCU 22k,-ID 2-- . 1 e-z,..s . t7___
........___...._
a:pf 1 fE!!,,,',o;ts!!!:d4e,,,Ct doaa.tt:2:c..t.„1,:ar!ec!Is tP,-.1:-..!;,e SS,..1 7;-.:3 7:`a S 7' -::iL3.:;:gc7;:,?..„.„.,?,..C.7,,,t,737 i 7 7:e'7 3_7„4,-3:es u^ 3.3 3.e. 1 11,-31;.:c9,pep;suei--,:n.t the
aSS3.55-737!.date C,_.77.e,-;ye,- a 7 i -
i ' \-- C 0 0 0 , be,s,,se-?
Xes
lire T,; st is h s!her erSst sha-e o=ints-est?
'If n-37:i.;C71 record i---d”!are,t tom t-at cf.app'seat i 7 7:za-,e bed. — 1 5 th prsperty i,c,Jest'on Ahrr,is,!y Assessed 1
FIL 11-4." D , .--- Real Property ci Annually Assessed i
i
Mobile Home(IC 6-1.1-7)i
74.----dd,Ls,".;T,--7-0:-...;,,,,,,,0- ootraot s '!‘sr(r a. ter a-::.sr-art oti sfaie.a,-.4 Zir c•-.: _
rtid 1 1 2022
(•-..71.i117- et e,-sig----1::4.---c. o'.5J,7(3v.,-.E., 61-hcf,1-J-Of r-.orrtgas,
-A2O-risoit ass!,S-J;;(s:JriTtet--,:d soreet c;tf,sfste 5-,!,ZIP co=1,71)----GIBSON COUNTY AUDITOR
_..._ .._ ::::Theo str,te a,,,,,t of d,d,,,,,t,o,_____„„„„...i
'1..1.3. la,'Os Dt-P !Has th:s dedioion o requested
Does'app!,zza:.-OZ- Ps-dchsc-ty i7 a-07 i l''yes v.hat.T.,....-'41,
„„ ,. I on property for ,
Frr-r,'c'-c;,.-,,,-;'' [_i Yes Li No ; ;CU-ent year? , Yes Li No ! ,
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or c nt et indebtedness that is recorded in the county
recorder's office Or aunty recorder's office)that is the basis for the deduction.
____. ..._........_
kt.1 D ITO R
._ ._Drawer NO... __
.420.Q. ,1 ‘
-- --------- —
20 r' 20
Card NO. 416.0
S:chatiro.oraoSInty c,...,nly 1 Date(rro 'S 3/y- -,
I 11 2_ 1
,,VVe certify u aeon is true and correct and that the applicant is a reside it of Indiana and i
owner/contract buyer of the aforementioned property on date application is filed
S,zi.-ature ',..a7er's fa,rarre,',„,
at
!•,,,,, rar..-d..., t address of 4:-..-.1i.: rz .,..,75,.-1a.--;7- trrse! r.....-!.::;1,;( !,-. ----d ZP ce.le —____
--------_ __
___
,,,f\'''r,,,ss Of aothohz-Sri person Iro,ber and st,... ...-t.c,ty s:'.a.i., sad ZiP reds, --,
The penalties for perjury can include imprisonment up to two and a half yea-,and a roe not In exceed S/0.000