HomeMy WebLinkAboutMortgage_Hatfield (3) ^E."—- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS _ County j Township Year
•' = FOR DEDUCTION FROM ASSESSED VALUATION —'
1 . 102�, 1
State Form 4370e(R,,/,-z» Gibson 7
`• Prescribed by Department of Local Government Finance I `2i'
File Mark
INSTRUCTIONS: To be fled in person or by mail.
Form filed with-
Filing Date Form must be completed and dated in the calendar year for which the deduction is sought. �✓ County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is
located on or before January 5 or the calendar year in which the property taxes are first due and payable. 1 County Recorder
See reverse side for additional instructions and qualifications
ppo _a•.(o.rre- 'eo 4-� _ - •,a...o rye err via side) —
K ::Jr'.�1`'l-.•11-s- d_sc^p:-c 2 I�R _)crrdd numbe I•
Paoe number
Tax:n:D sue_ .-�2—' J �1 _00 I ���_O /~ �
(fit J\ • O ! 12 l
Aaaaaad.v=ue of reel prooerty t:'or tea.ge i Cont-ac'.indette_dness u^ra•,as c 111, _gage/Cc'nt i-.d=b•ad-ass u-pa•d as of Is the app1ic nt the sole
a7 s t, c -a._yea a assessment date current ye_ oil • a �� legal o•a able co -ri-?
dYes C No
If ro i.. ,e.is h a!her eras,shame of interest? i If owned,1.•:so•..eone Tithe-than spouse indicate v.'tn whom
1
;
1 If na•-e on record is d.`fere^.t than that et app1c-
t.indicate be'ow j I-the..ropeay in question Annuat!yAsse_ssed
1 I y E.]Annually Assessed
_ AI Mobile Home(IC 6-1.1-7)
Adde,ss of mod-gaoea or contract s.':^_*(nurnder and stria_ ity Sr3te.and ZIP code, MAR 18 2022 --
N a-re c`assignee o-other owner or ho'de-ct mortgage — -----
ee(rumtor aid street.ci!.state and ZIP ccd ---
qd -ess c'ass•,=r i GIBBON COUNTY AUDITOR i
o 'i 'Ta<'cg D-st-ct'' !Has the deduclo a re^uested I`yes state e.n.aunt of de.ucPon
Does app'iant o::n property in any i I'yes why' y _. .•.•^
other count/ j on property for I
i in Ind ana? ❑Yes [ 1 No ! — _ -- ;current years Yes ❑No 1
A person is not entitled to this--d ion .!e he - rson has a balance on the person's mortgage or nt ct indebtedness that is recorded in the county
recorder's office(includin—- qui line •f credit that is recorded in the county recorder's office)that is the basis for the deduction.
_` "; ___ _ COUNTY AUDITOR
Deduction aoprov in the -f I
20— 20 1 20 20 20 _ 20 20 1
S:gr__..?o`C i1 ter 1 I County \ 1 . \ ' Date(month ;,;,alrt) r�
I I We cert•fy under a penalty of perjury to . . above and foregoing informat on is tr a a. d correct and that the appi canalr� ent of Ind.ana and I
buyerofthe aforementioned property on date application is filed. i
X ow:ner/contract P P Y L (/�V/��
S u-elo�'�� Jr'�na i / / IDa'=_ n.l• dyl
if IL/� � .i l 1 I ��
fe re -d re _ - numbs'and s.rs c•. s!a._ d ! code
1�11 �� ( ,sower— `1 C` — `�— L11 �' �
Power Attorney^r b IC6-1.1-12-C 7 i Date(month.day year;Pe sin a_.' ;Z__ /duly y o i Y
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Address of aut.`orized person (number and street.city state.and ZIP code: i
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The pena;t,ec for perjury can include imprisonment up to two and a half yeas and a fine not to exceed 510.000