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HomeMy WebLinkAboutMortgage_Johnson (5) . A---- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township Year ,£ .. _ FOR DEDUCTION FROM ASSESSED VALUATION ! !�` y � S:a:e Form 43709(R14 I i-2Ji j Gibson I ©\ ' �O Z.L-- 1 `. Prescribed by Department of Local Government Finance L_ - I File Mark INSTRUCTIONS To be fled 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 aC/ County Auditor Must be filed or postmarked with the CountyAuditor 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. 1 lI County Recorder See reverse side for additional instructions and qualifications. -A?p:ican (citric corra_: re-..^ton5cnni_r,, s"d., Moue-l. ry 50. Jo o 7_=.xin_.D"s-.- 1 Ke,•number f leca'd=acn t o- 1 ,4n2 Record number (Pa =number -i - 10` -L�---00 2- Oo 3 O L1 Z- 01�- - ,4 h 2 Z I 31 -J Assess=d ye:us o'rea.pro-er: _c- t:'or:_=_,e.,Cont-ac.io.:ec:eeness u^pa'c as o I +o•ga,e I Ccr:.t of t-ice.tad-e.ss u ,.a s o• Is the a- '_a .t the so'- • - assess-art date.current yea, assessment date current yea• date o'a ptc=_:ion 0 lege'or^ lu able own.,-7 O es C No ' If ro what is h c I her exact shale o'interest? 1 If owned with so .cone ,her "an spouse.indicate vrth whom If na're on record is d.`."erent['en that of app"cent ind•c_e be:o:: I I I e prop-.y in quest on Annua'!y Ass=seed !' .Real Property []Annually Assessed Mobile Home(IC 6-1.1-7)ii • - Name o ^_.o 1co' Cr:-aat s ,S- - FIL F Et 'Address o'rortgace e o-contract see,(hunter and street.city st3'e.and ZIP code) -- --F-E"-rttit ---'• --I•4H-1--2 .--- . i76 02 _ R- GIBSON COUNTY AUDITOR i •py=5 Q`/ l/ [ ;r.r.3 D.st_i-. !has the deducto.be .,reduce:ed I I'yes.state amount of dad•ctlan ! ` /\ Ion property for 'other V � I� 2q Z�� 1 current years Yes (�No 1 i -I in Ind r ---.-� A per DD l \{�''`�t^`�frr+ce on the persons mortgage or n act indebtedness that is recorded in the county rpcor �'1./ \ '6 v ` 1 riled in the county recorder's office)that is the basis for the deduction. COUNTY AUDITOR - 20 _i______ i 20 - I 29 20--- -- 20 20 i S•geatu a of County/I.:AAor 4��' - -- �- I County Date( c j �'a� iNflo I!We certfy under the penalty of perjury that ove and foregoing information is tr a d correct and that the applicant i a re dent of Indiana and owner/contract buyer of the aforementioned property on date application is filed. e; ., � Date t ron: day year) a ut s•r' :address o•apclu.zrt(r -n�er end strew, c•q state ^.d ZIP cote; f Person aut-enzed by duly executed Pcce-or Attorney cr by IC 6-1 1-12-0 7 I Date(month day yeari I I Addrass of authorized persor (rum3er and street.city state.end ZIP cede: rti.,, ae,y<sfnr ceriunclude tmprisonmen't up to two and a half yeas and a fine not to exceed SiC.000