HomeMy WebLinkAboutMortgage_Higginson .sE-"> - STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS _ County j Township Year
L . FOR DEDUCTION FROM ASSESSED VALUATION _
e State Form 43709(R14/1-23) A _
— Gibson (T� 2� w2
`= Prescrbed b7 Department of Local Government Finance C J
INSTRUCTIONS: To be filed in person or by mail. File Mark
Form flied with;
Filing Date Form must be completed and dated in the calendar 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 property taxes are first due and payable. El_ County Recorder
see,reverse side for additional instructions and qualifications.
•App'cant o: e-a-eo-tr of buyer-see rear lions
gcr`l_verce rda)
Tax;r D s'-. Key r.:��o fear-4 description G/�� / _ umb -
- .2 -�</� - rye-GZry // 7—Qa/.l d ' IPcr 9,
Assessed va'ue cr rear pro-=' - t'or._age;Cont•art indebtedness u-pe d es o I Mon3aTee/Contra_t indebtedness u^-a-d as cr Is the 1
assess-ert date-.ccr.ert yea- assessment date current yea- .date o`apyica':on � aoPt'car,[the sore_
- legs' •a rta5ie o:;-o-? -�
If ro v.-hat is h s I he•exact share o'interest? C/lYh Yes No
I`c::ned v:ith someone other than spouse.indicate with whom
I
If name on record is efferent than flat of apprcartt.i-d':ate beta:: it:a Poperty i�question on Annuat!y Assessed Property Real Pro l
� P 1 CI Annually Assessed
-- _. Mobile Home(IC 6-1.1-7
Marro:g=__ee cr cont-a,('s=''r- ` , ---
Addy_ r mo.'.4 'L'eontract se.' •(rumte -d street.city state_.anal ZIP cod=i —_ o _ ?
�/ 4 N
Name c'assignee o-Other�..__ j'
---'-.. -_' --_— - __ y _—- _— nt
iil-
.3.J Y �1 , l-
Address or ass'cnee from ---- -- i
Drawer NO... �� a o
Q
�T Z
Does appa_ant o:.^p•opr.' U yU CI 'has this deduct o b n requested 11` state a-noaalLastduc i _—. ---
other county U !on property for lea TT""�—TT ton
I in Ind:ara7 ❑Yes_ T l current yea" Yes ❑No m
Card NO. i _ _ _
A person is not entitled is mortgage or c 71 ct indebtedness that is recorded in the county
recorder's office(include corder's office that is the basis for tr,t
_ 1 wction.
COUNTY AUDITOR ----
Ded..ct:cn approved in I^_-ar-, 'cf __. ------ - —_____--
de"-
20 20 20 20— 20 20
-- 20
S:gna•. or County P:ud:ter •
, Cc_ ------ [Date(r,on day year) 1
!
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I t We cert fy under the penalty of perjury that the above d regoing informaoon is true and correct and that the apprcan is a resident of Indiana and
owner/contract buyer of the aforementioned property o application is fled.
ne Date(monthday year)
• FV'^rs'ae :address Or ar_li 2r. :'Jm__ c-d S:ram_. !a'-3 old Cc i
• .,-7/n C`
Perso-n a.itrorzad by duty exe:uted Pcwe-or Acorrey cr by IC 6-1 1-1 -C 7 i Date(ma nth( nth.day year)
i
I
Address of aut`crized persor (rurrber and street.city state.and ZIP coda,
The penalties far perjury can include imprisonment up to two and a half years and a fine not to exceed S10.000