HomeMy WebLinkAboutMortgage_Robling (2) � a,.Pw=.4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County j Township j Year i
fq- : FOR DEDUCTION FROM ASSESSED VALUATION
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•!- Gibson { 0 �'g oZ2 '
`x4 •- state Form 437C9(R14 I i-zJi
Prescribed by Department of Local Government Finance
File Mark
,NSTRUCT(ONS To be filed in person or by mail. I O C
(�V` Fcrm filed�rthI
Filing Date Form must be completed and dated in th_ lender year for which the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is County Auditor
located on or before January 5 of the calendar year in which the p-ooerty taxes are first due and payable. I! County Recorder
See reverse side for additional instructions and qualifications 11�e(��en � -� C�c�1es--- e
-A?p^.an' -n<-o-con' b see restncfrons Crreverse s�dej
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Taxi- D's• cl u-b legs.'desc:piton I Record number I Page number
p 1 b 2 =-o -j2-400 ^001 . .5�6- 018 • ' 2�� 060
s u-c`real peg - 1;or.^_age 1 COn:'a ct!ndez:=_dne-s unpa'd as o 1o'gage/Corm '-.cute,-sss unpa'd as o` Is the_
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Assss _ _ proper:"_-^` - j e Pcart the sods
assess—ere dale.current a- a>6essment da]e current yea- dal a tic=':o�, le a'or taoIe owner?
WV. Yes CNo
If ro what is h s!her exact sha-e o'interest? I I`owned wit•someorie other than spouse.indicate w`th v,hom • 1
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If name on record is d..`.f=_rent than teat of app"cant ir-d ca.e be'o:: E grope.y i-qu=_s`onAnrnal!yAssessed�T eatPrperty []AnnuelHAssessed(-J �j.JJ�� Mobile Home(IC 6-1.1-7)
Name o'rro tgagee.Cr contract se:Is- ..? I y)1 . ,
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---- APR 2 2 2022
'Address of mo•-tgartece c-contract setter(rur rber and street.cit./state.and ZIP cadet --'
Name c'ass'.g-n_e or Other ov.-Ser or holder cf mortgage - _-- a D:rOR--_..-- __ j
GIBSON COUNTY A !
Palo e ss of ass.c-ee(r,urr er ar:d s!reel.city:stale and ZIP code_) ----j
Does appIiant ow,-proper:"i-'any I'yes what county-7 !t'dha'.Tax•cg D•st-Ict7 j Has this ded.,—on en reo,,usted I i`yes state amount of deduction
other county i I on property for ❑
in Ind:era? [J Yes E No i I currentyew-, No ye i Yes 1 :----
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or on act 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
De.Crton acproved in the amount et
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20 l 20 j 20 20 20 i 20 ' 20
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Signature of County P:ud'(�^, /1 � County C^ • I Date( da/(Yeari
— 1 1 llw i !�'n 1 y�21-,1i0 r—t •
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I I We certify under the penalty of perjur -t the above and foregoing information is t and correct and that the applicant io a resident of Indiana and
owner/AWity,),_
contract buyer cf the afor-. -- ., prop -y o. 'ate application is filed.
X S4.. `� s ` !Date(wort^ day ye.e-)
Ft,'^ s de. o,apclic 0 s:✓' -stir= c' stare a^d ZIP code.
we-Jf Atlo`r•=.! b
O r IC 6-1 1-12-C 7 ;Date(month aeday 3-:trCr�2c_by du!‘"execute1 year;
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Addr=_ss of aelhor zed person. (number and street.city state.end ZIP code:
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 510.000
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS •
Name cf acc!{c 'Na
\�� /ob)1nJc ti IMF)
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Dale filed wort^ day yea') ;Amour of indebtedness- �'.ne District
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Key number Iega�.description 2 C•^ Of _12^1 0 —OO1 5g 6 _,rXif ryt ` 2 2022
I b 4 /_mil `J l O -//,.-
S•gnature of County Auditor ryounty accr r ' a,yY Date {ray ye
`V1\ C �` NTY AUDITOR j L`\mcnThar)
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