HomeMy WebLinkAboutMortgage_Lloyd (8) �t�E=,-s-- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS _ County j Township Year
yell FOR DEDUCTION FROM ASSESSED VALUATION
`-� �i State Form 43709(R14/1-20) — Gibson I �a—/ as
`..> __ Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be fled in person or by mail.
Form filed With-
Filing Dale- Form must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is County Auditor
located on or before January 5 of the calendar year in which the property taxes are first due and payable. I County Recorder
See reverse side for additional instructions and qualifications
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assess ._..t date current yea' assessment dale cu Her: 'ea" date or and -on ' -
y . . Ieca'o-eGuitab'e cr...,-1.,? I
y o Lam' E No
'If ro v:hat is h s I her Er.a st shale 0`int_-r2s:?
i If c::ned r:ith son: on_othe'lion spouse.indicate v:`ih whom
'I If nerve cn record is d.fferent['Ian t^a:c`applicant ind rate be:o.: I Is the prope:y in ques`'on Annually Assessed
I Leal Property []Annually Assessed
Mobile Home(IC 6-1.1-7)
•Name or mmtga_ee or con:-act se.lte-
• >�.� fE[L E D --.
Address o`mot i- c contract Hurt=:and street.city state.and ZIP cod,i
Name c'assignee_or other ovne_r or he'de"cf me,gage ----
MAR 1 1 2022
Address of assiosee(number arid street.city.slate and ZIP ccdn_j _---_— — —__—_____-___ _ ___
Dues app'r_an1 ors..prop•eny in I:yes ',hat county') I h'.hat Taxing D-s:-ictn Has this deduct on been -1�2' d r'e;ct:on
other count/ •on property for (BS,AN OO{Jry A I`(' K e
in Ind-ar.2', -- ° J 1- I Gwen:year? -_ es o 1 ______
.—.
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
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Dad.._t:cn aop oved in the srrount of —
20 20 20 20• 20___- 20 I 20
S:nna•::• of County Auditor i County Date(month day yea,) i
— �/`-�� INS �1� i �a f J 5.,de" �t(/
1/We certfy under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and I
owner/contract buyer of the aforementioned property on date application is filed. I
S ^atu'e Iowner's fur name) I Date(mont; day yea l
C.I.a. ' V r1 O"'t•CA 112.02.Z •
EL.!'re 'dent ad_ess.q`•apelicar: nu'nme _ cityo..c
-d street city slate e-d ZIP c _;
fQ `IU'1 W— c o15/ ;Nike.-e-VOw� sw y rlt,,'1
Pc-s_n aut`or,zad by duly executed Pc er or kt'.or—7 cr by IC 6-1.1-12-0 7 i Date(month.day year; .
i •
Address of au:^ohZad persor (number and st•eet.city state and ZIP code. !
The penaltes for perjury can include imprisonment up to two and a half years and a fine not to exceed S10.000