HomeMy WebLinkAboutMortgage_Shipman I^•�► STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS county Township Year
y�* FOR DEDUCTION FROM ASSESSED VALUATION 12 r/7/fin/
a State Form 43709(R14/1-20) lJ� "� 0 `�
Prescribed by Department of Local Government Finance J
File Mark
INSTRUCTIONS: To be filed in person or by mail. Farm filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. (�� County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is /El County Recorder
located on or before January 5 of the calendar year in which the
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Taxing District /��s ev nnmbpf7 legal ipription 3 0 t`^J a
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mort, ge/Contract indebtedness unpaid as of Is the applicant le the soleowner,
assessment date,current year assessment date,current year date f a plic@tiono 60 legal or7itab
// //II ®Yes ❑No
If no,what is his/her exact share of interest? If owned with om one rer than spouse,indicate with whom //�1
If name on record is d' rent than that applicant,indicate below: Is a property in question:Annually Assessed
L FILED Real Property ❑Annually
Mobile Home Assessed 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) APR 1 3 2022
Name of assignee or other owner or holder of mortgage �y7� , t
//Leduc-, a..tiki iS.rtdJ
Address of assignee(number and street,city,state,and ZIP code) GIBBON COUNTY AUDITOR
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction en requested If yes,state amount of deduction
other ty ❑ on property for
in Inediana?coun Yes ❑No current year? Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or ont 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)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 boil
20 20 20
�.�`- 1- CountyDate�rrOnt ,c a, `,
ignature of County Auditor xl
...5 C /`-�(11 c •
I/We certify under the penalty of perjury that the abov and f going information ig true and correct and that the applicant is resid nt of Indiana and
owner/contract buyer of the aforementioned property on e application is filed. �/
• nature(owner's ull name I Dats(r(�o h, )
(.7.2,
�� V resident address of aPPlica (numbs and,s\�\stt���^@'�t—,city,stet g1nZlP)code)
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Person authorized byauly exetut Power of Attorney of by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
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