HomeMy WebLinkAboutMortgage_Jines ' i STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS L County Towns
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/;‘ c1. 1.e._ FOR DEDUCTION FROM ASSESSED VALUATION
np Year
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\!::144,t1, --/- State Fear 43709(R14/1-2-D) ! Gibson !yoko V6Cr !
-....-1,...._ _. :.--- Prescribed bj Department of Local Government Finance
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File Mark
uvsTRUCDOVS To be fled in person or by met/I.
lil FcLll:f'cGeora7u n:tthyy-AR-aute-dc.:0Ito_er,-Citing Datia Form f77LISt be completed and dated iri the oaten:la-year for v.inch the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is
faceted.on or before January 5 c=the ca/ondar yea-in v.ihiori the ptoperly taxes are first doe and pe.,:able
See reversc side for additionat instructions end gJatifications
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'TON.1.0...---6 k.)AA 1 ., 6-0 q-Q•5"- /0/-Cx...,C7. 0 -3-Cia.. C.7 A,.,,,,,,,--vs.as:°Ines c.,...-se7ti as c= I Don...2..adoe.I Cent-as:issletzedness assa a as et' I Ms-Cc-ass,i Cre,ht-asI ihde-Cted-sae,.anpa-e.„.s.e., i 15 tr.,,,-;',p;,:::,,,th,;—,:.:,---.., —
assass—ehl date cussen:yea- ressess-cce.st date cu.-rest yea- 'date e`-lande'lset-ch 1
: '31 8-75.°e" 1 -s CT Na
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Ihre ‘...-....edis h s/he-exact shace eintenest? - ---------------- I If c....sed a it's sol'nenae othe-0-Ts...-,spe0s isd'aete v.!th.....h'srn
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• I f-na-e e----1-r-eC-----n-C-Csd fferest tse-fine'.cf e'en'cant isn'...see ne'n... ----------------------— ----------- I-fis tae prspe.-hy V qa.s/st'sh Anlly fssees-s•ea
'!1_72 .2!Property El Annually Assessed i
f.labIle H acne(IC 6-1.1-7)
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MAR 0 9 2022
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eh; s!e-:ta a 7."7:Z.I R CC 7,,2)
1,9,N41,COUNTY AUDITOR
.‘.-_--3 v.-hat cadndis le,v.,.D.st-Ist, 'Has to deddst,es,been r ,..o..: ._
1 en prope,ty fe- G
A person is not entitled to this deduction unless the person has a ba'ance on(he person's mortgage or contract indebtedness that is recorded in thit,county-- -
recorder's office(inc(uding any horre equity line cf credit that is recorde.d in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
the Cr.arneana--..cf
20
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S,,,,-,-at_.,e.--8T—d'onty/Aurrftc-
i i ie ce,,,,,under the perta!IY Of Perfi-lrY that the above amti fors-going informs,on is true ad correct and that the appf cant is a resident of Ind and and
u.-iner/contract buyer of the aforementioned property on date adel cation is filed '
- ../SCsnatase.DT:secs fe,hanne; !Date(a-cat-, de!!.- yea-
an _IT- -es.an Pd...e-of itSossei or bi K2.0-' 1-12-c:7 I Data(rhsath Ca-, yea-,
3/?,/c
ess Jthonzed.persdr (nernC.,er and staest.c.ty stetns and ZIP cede
he pe.nalt,',.9.$fc,perjury can include tinorisorme7t up to two and a ha'f years and a fine not to exceed S1 0.COO
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