HomeMy WebLinkAboutMortgage_Burgess (4) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS 11 County i Township —1 Year ---i,
FOR DEDUCTION FROM ASSESSED VALUATION ------
t-...
Suite Fun rn 43709(R11.I 1-20.1 1 Gibson ) 2- <-1f, 2_e__,
-..--•..„..:.,,, Prescnbed bi Department of Local Governme-lt Finance
File Mark
INSTRUCTIONS- To be?fled in person or by mail.
Fe Liyfir:i7 CCe ood,,....''rir-1.ttl:y,1..k.Fzuedlo!to:::Filing Da!,e Form mist be completed and dated in the ca,endar year for which the deduction is sought
Must be filed or postmarked v..ith the County Auditor or County Recorder of the county where the property is
located on or before JF.I'../Dry•5 cf the, calerld.-c-yea'in v.hic17 the p-operty taxes
Se=r reverse de for adddiona!instructions and qua'ifications
7 App"Ican: .. -: '"-7 co,r :-.!-E.-,•,---i..; !,-;..-,i'.c, r ri-,,,e(-‘ze, r-7..;
-
[
------_____.
_ ...._,,
T-;',-;.,.0 , I Re.•r r-rb,-2,.'1,7.7.-i'desc,pl cr ,Reo.coe rh.,-eb..- !Pao.,r,er,b,-- .
'' 2r-r-)\ — 1 2-•—!k0, -.-0 02. CIO-d-2-a ! 2-0 2_7).___ i ,6s---4__ :
•
t.'sr--eaed.i CO-....-eet 1-,debess,..(-ca c es ...lo•-- a.See. C,..,-,t,--6.7..... --,----------
a-,sess-er!.dc,..F.„ C".:•-•,""..,,,,,..1- aSSei"..-_,,I•e"It.date. codeot y-.7.e- C .-"C --C..6
C''-•S-../. -° 1 le2E,'C' C''''..30',.-,0.,,,,,•? ;
-fri...„7, ,..:::--,,,.is h::: he-er37).sheui o'ints-ost7 !If d....-oe; it',s ---,• e•Doe qthe-t7e-•.----SpOoSe ied•oz•.,! v.th-....! ,
. ,
• ,
If rc7;--(:;---eh!-.r!..o.-.7--'is o!7F-s4••eht the-t!--a'.of Ls.;74.-...!:dot ihe:e's,..te'.e1-!..-•---------------------- --—- ------------ --T-- c-prope-ty io quest!-, Aoo-:--ri-iVASse--;-s----Te!--------1
L Rea!Property El Annua!!y Assessed
_
Loble.Horne(IC 6-11-7)!
_____________.________ --
• r...'-a----7-,,,..r., 0-7,--s7-:-_•:(--Ticecee.7c---c....,,ra. se' -..- 1.41 I ____.______
-EDI
•AT:1(1-,,s.5-0!r-0:-.C':,(-(2ee 0-ccri(,3c,..sE('!cr(r,---.:,-,-aoo's!,...o,! ch.'y a-,e4Zi.*;.-Te.
--ka----ra-ii-lra5s,g.rae o-ore-o--,-.....-..e.,o-hce-s cf roust,,,-.1„-;e --------------FEB-2-5-21122—_____.
It aLLUTI AUDITOR
Dc---;:j-a-Tplc(3--r..c.,-;----P--..c,c,rti-i-ar.,,. 1 l''y,--; v...,at.,...,,,..,^ - - - - 1: .(70!•3',.,•Tt".-,..V., 'F a-s t=rs.da..:!..r.:t,or a r,recur:star( !l'yes s'..-7:ta.a-r..(.1_,r7:67---er(7:-:-(icTn.----- "I
otrie-CC/in'.., -- , i i I on properly for .--- 'yes L
I !
in 1,-,!zoh.:"7 L `,i es 1----..No 1 cu-ren(yda-7 • Yes 1.7-1 No !
. „_
A p.,.rson IS no entit;ed to tms deduction unteSS the person has a baranc,e on the person's mortgage or c nt act indebtedness that is record,-,J ir7 th,county
recorders office Onciod:ng any horse equity line cf credit that is recorded in the county recorder's office ,-
tha. 's the basis for the deduct on
_ ___
_„__.__
COUNTY AUDITOR
-------- __ _
C5-d4 .--O.7-•eop.:,.--;.re-O...e!the en-suo I of
____
20 23 23 20 20. 20 20 ------------
_ ilr•. '
I .
S',,-., o(Cc.....(.-.••,(.4.
0.A.A.\...
libli. Cr A
I V.,'e,cert fy under the vena!ty c71114121,that trte above and foregoing informat,on is corect and that the app',cant is a res!dent ;1!-Ictone and
owner I contract buyer of.the aforementioned properly or date app.i cat on is filed
Da`...?..(r.r ,-;-, do/
n- \-a--G` \ ° •
_ _is •Pc x ,. ...:
Re-se-7 zoo%-y-,.,,!,ee--... ...e ' Qf Ar.':,-,....;C., C 6 _,,
bi I -1(1-12-,7 !Date(•,---or:rd7 dey yos`.
"--ste.,-eys-s•OF.a.f."-c-;zee pers-r- (oh,re..t.,€r e.-sd s,,,eet d'y s-,•!= eed Z15c0cro.-7------------ -;
---- —
_ ----- -- ---- ___J_
rh...,pc,e':,e,s nor periLlri ca;include imprisonment up to tz.,c,and a ha'f years and a fine not to exceed S10,000