HomeMy WebLinkAboutMortgage_Poling (4) s^-;hv STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
441, FOR DEDUCTION FROM ASSESSED VALUATION
Q •i.} State Form 43709(R14/1-20)
*�,. —.' Prescribed by Department of Local Government Finance
IltrlitINSTRUCTIONS: To be filed in person or by mail. y�+
the calendar year for which the deduction is sought. itor
Filing Date: Form must be completed and dated in
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property PRisA , ^2 County Recorder
located on or before January 5 of the calendar year in which the property taxes are first due and payable. Y Co
See reverse side for additional instructions and qualifications. C
Applica irip=r or contr ct buyer-se scions.. ers-side) / ' ' GIBSOIV Cou •�!rgyt;"_
�-,0 r ' D Record number QI- alr�14.ln/umbe�
Ta�.Dis rict Ke number/legal des•ri. ion �/7
4-/a -el OfQ-O6/ aoi - O� � Gal J
Assessed value of real property as o Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the
applicant
e sole
owner?
assessment date,current year assessment date,current year date of application 9 Q
date,.
d ❑Yes ❑No
If no,what is his/her 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:
Name of mortgagee or contract seller o /y//�
Addres. ortgage contract seller numb47.0
/ .!' fate,a d ZIP code `�
r o / � �� Drawer NO '
Na r al nee or other owner older of mortgage
Card NO. I
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? I
other county i
in Indiana? l�r—,/L`_I Yes o - -`)
A person is not entitled to this deduction unless the person has a balance on the person's mo7 I.t��'
recorder's office(including any home equity line of credit that is recorded in the county recora `-I,.'0 naka ``.
COUNTY AUDITOR CCU - /�
Deduction approved in the amount of; �` r .1 n „
20 20 I 20 l I 20 _ ri
s�7
Signat of/unry udit 00. al County Date(month,day,year)
I/We ertify under the penalty of perjury that the and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned pro erty on date application is filed.
Date(month,day,year)
Sigtkture(owner's full n e p
Fult resident address of applicant(number and street,city,state,and ZIP code)
)) qb1 Sou + r-r STcfFe5 DV AR8NLIFfo/ll /d. Ll-7676
i ntf,d
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date oray.fir)
?
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$10,000.