HomeMy WebLinkAboutMortgage_Bilderback (4) -eT STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS j County j Township I Year I
FOR DEDUCTION FROM ASSESSED VALUATION - 1
`��i . State Form 43709(R14/1-20) j Gibson 1 2q- _L---�7 O�
` jy Prescribed b Department of Local Government Finance L_
1 P 1
File Mark
INSTRUCTIONS: To be fled in person or by mail.
Form find.•;ith-.
Filing Date Form must be completed and dated in the calendar year for which the deduction is sought G✓ 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 year in which the property taxes are first due and payable. n County Recorder
See reverse side for additional instructions and qualifications
•App!'cant(r3�re-o•contras'6. -1\s�( strict- n�cr rev -`side) _
Taxing D'st-ct I Key nu-. r I I- a -r. _ 40— t_ ,RCS n" /- •p -n•C.o'
<+s=ess=d v:ue o`;aa'G`o-=_•y a-_ i I'.'or._a�?i Con:-a c: ❑debredness u .a...as o 000 ,I +.o'.3a_ I Con - i-c=deed^essyt^pay as o. Is Ir;e z_ an[we so'=_
assess-rent date.cure:'t yea-
;da]e current yea- i date o- pain �'1 '�v\ legal o� �uitabre o:•:ne-7
OYes C No
If ro v:`•at is h e!her exact share o'interest? I If owned`with so :cone - a-th.s us indicate w'fn whom
interest?
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If na*re on record is d`=_rent the-that of app',cant indicate bc'o. i I th property in question Annua'!y Assessed
1• Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7),
h 3"-OVga^yeOn, I
Address o`ro.y ee t seer l -- FILED __
DI l de•C ack , TOriS F ---
Name assignee other o�.,er or Fcde-cf me APR 0 8 2022
Fddress cf assignee(r.:mtcr ai:d street.city:s. 3 0, o O a t 0e, --
f
O^es app':ant o..'property in any I I'yes ..` be':re qusakillS?f •6014MPYa4UB1T t:on !
I
othcrccu'i ❑Yes C No I I 'es ffl No 1 ,
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or c tract 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 t t is the basis for the deduction.
COUNTY AUDITOR
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Deduct.on approved in the amount of — -
20 I 20 1 20 • 20 20 20 20 Ji
S:Cnat_.a of Cou^.tyA:J��to• ' County 1 Dat (rr'o ty 'i
cakr
s.
;• e and foregoing information is u.,and correct and that the ap Meant i a resident of IncVana and i
I/We cert:y under the penalty of perjury that the abo � � P
owner/contract buyer of the aforementioned property on date application is filed. I
.I ) Date(wort:; day yeah
sd=_: d-'r=,s o`.appc�i�ja\ar: num�<!_.-d. __' c•'/�st�-� �I,_ q- \ l�V Y
thf S V\J I 1`1 1C/W^1M VcA�J
Perspn authorize_by duly executed Rower of ACorrJy or by IC 6-1 1-12-C 7 i Date(month.day Year)
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Addr.ss of authorized person (rumba:and street.city state.end ZIP code'
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