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HomeMy WebLinkAboutMortgage_Grubb (3) ^•4, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year r FOR DEDUCTION FROM ASSESSED VALUATION ��J�✓1 M ©� 2 ^2rL State Form 43709(R14/1-20) v C/" ,. .� 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. X County Auditor Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is County Recorder located on or before January 5 of the calendar year K \1�J Taxing District Key number/I A description r�&-cf^Q Record number Page number 0 -- •� —�03 — O s v 1 _ �2b{ }y Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortg ge/Contract indebtedness unpaid as of" Is the ap licant the sole• assessment date,current year assessment date,current year dat appljCoq v v 0 0 ^ legal or ble owner? es ❑No If no,what is his/her exact share of interest? If owned with omeone othgfthan spouse,indicate with whom If name on record is different than that of applicant,indicate below: the property in question:Annually Assessed Real Property ❑Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller CIT ` Address of mortgagee or contract seller(number and street,of -------- - ----•----- ---- - FILED Name of assignee or other owner or holder of mortgage �0 1 Drawer NO 1 APR r 2 2022 Address of assignee(number and street,city,state,and ZIP a 7 - J �7 Card NO. ! "`�-Cf ye Est t of deduction Does applicant own property in any If yes,what county? 'GIBSO(\oCp(tNTY other county AUDITOR in Indiana? Elves No A person is not entitled to this deduction unless the per mess that is recorded in the county recorder's office(including any home equity line of crec s for the deduction. Deduction approved in the amount of: 20 20 20 20 20 20 20 Signature g ty Au ito County Date(m nth,day,ye r) I/We certify under the penalty of p ry that the above and foregoing information is true an correct and that the applicant is a side of Indiana and owner/contract buyer of the aforementioned property on date application is filed. XSefVT�,,��lff�((��jl(o er's full ame) Date(mpnt1,y8y yla�1 ^ ` VFu fBSident address pplicant(number and street,city,state,and ZIP code) l/`mil I L (/�, L / \ ` � t1 `'•"_ '�� Person authorized by duly executed-PUr 0/Attorney or by IC 6-1.1-12-0.7 Date(month,day,year) Address of authorized person (number and street,city,state,and ZIP code) The penalties for perjury can include imprisonment sin to two and a half years and a fine not to exceed$10,000.