HomeMy WebLinkAboutMortgage_Miller (8) �-Fr , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
r ;c=. FOR DEDUCTION FROM ASSESSED VALUATION /
?=1"' Stale Form 43709(R14/1-20) G. 1 1 b. �h KQ1 t c2Q
--'-„_ Prescribed by Department of Local Government Finance
❑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 o/the calendar year in which the property faxes are first due and payable. ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Ale/15,50.. /Miter
Taxing District b.S-k�df' Key number/legal description Record number Page number
Pav -e-'10-yoa-boo. �y°°q as dZ3=.26,
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
meet date,current year assessment date,current year date of application legal or equitable owner?
/of,-559. m-ves ❑No
If no,whet is his/tier exact share of interest? If owned with someone other than spouse,Indicate with whom
If name on record is different than that of applicant,indicate below_ I,stthonroperty in question:Annually Assessed
[l .
eat Property [i Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of^�OWepee or contract seller FILED
Free�Dw', M or 1-go�ge Corp.
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) /
Name of assignee or other owner or holder of mortgage APR R 0 6 2022 j'( / ,_
Address of assignee(number and street city,state,end ZIP code) - V
Vha;4.ta.a.( )
Does applicant own property in any If yes,whet county? What Taxing District? Has this deduction be t9itl C[ytritisSetwurEnnytolkeduction
other county on property for LV3 Y
in Indiana? Dyes O current year? es e8 Ill❑No
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
Deduction approved in the amount of:
20 20 20 20 20 20 i 20 ---
Signature of County Au itor / County Date(month,day,lyearj
GVTAI/� G 66o Lf/&/tea
I 1 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.
SI tg!d4[.(s fulneme) I pate(month,day,year) •
- 12I -V� •!1(1 r_o--e� O U -n 1, -a 0.
Full resident address of applicant(number and street,city,state,and ZIP code)
10t( .$J- Nat..b,5f,d1- ri✓ y7G�
Person author zed by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,stale,end ZIP code)
The penalties for perjury can Include imprisonment up to two and a half years and a fine not to exceed$10,000.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of applicant ����"" Name f mortg gee or contract seller
"�C i 3 /1�I((er o
m MO r 1-4.% C_o r P.
Data fled(month,day,year) Amount of indebtedness Taxing (strict
`1/Co%?, oe 631. `� t-lyyA���vggqbsfTozili-
Key number/lapel description IE-ig-36- yo o. o9y-ter
Signature of County Auditor der/Cqun Recor ty l
aun
Gibsov\ Aviee6 2022 -
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GIBSON COUNTY AUDITOR