HomeMy WebLinkAboutMortgage_Braselton (2) /;,.<Ry>F STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township Year,
44. FOR DEDUCTION FROM ASSESSED VALUATION
tx ) State Form 43709(R14/1-20) Gibson 'o'kn 5f?,� 2020
- Prescribed by Department of Local Government Finance —
"-"- File Mark
INSTRUCTIONS: To be filed 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. �j 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 of the calendar yertiCn which the property taxes are first due and payable. O County Recorder
t^
See reverse side for additional instructions and qualification YQsei" G
fiVd r�Applicant(owner or contract buyer-see restrictions on re a de) ,/_ G-4-2
Qv ��+�n S 13ra ✓� /VAU(A,
Taxing District Key number!leg scnption ord hum er Page number
a aG- 3-o - Liw- 00% $83 - bay moo' — i i
Assessed value of real property as of Mortgage i Contract in btedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the so e
l assessment date.current year assessment date,current year date of application legal or equitsple owner?
es Lil No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name or Is t roperty in question,Annually Assessed
Real Property 0 Annually Assessed
r Mobile Home(IC 6-1.1-7)
�J
Name of n �1
__FILED_
Address o �A) 'NOV
Name of a NOV O 5 Z021 V
,(��AS�L TUB _
Address of assignee(number and street,city,state.and ZIP code) a, ,,/�
t$ t O S Y..Pp�1�PJmoounntt of deduction
Does applicant own property in any If yes.what county? What Taxing District. Has this on property
for io UI �_.Sty..
other county 0 Yes ❑No current year? Yes L i No
in Indiana.
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or nt ct 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 tha the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of'.
20 20 20 20 20 20 20
�
Signature of County Audip,r County !// Date(month.day.year)
1 /t� Gib Sow i - 5 -mil
1- II We certify 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
owner/contract buyer of the aforementioned property on date application is filed.
Signatur owner's ulliz,. ...,__, Date(month.day.year)
Full resident a dress of applicant(number and street.city state.and ZIP code)i logo s, o�.k(-vdsc L s 1 .�s , r4 s4, I/,L. L�7 6 3
iPerson authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day.year)
II Address of authorized person (number and street.city state.and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.