HomeMy WebLinkAboutMortgage_Higginson (2) -a. y----;, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS _ County j Township Year
!4 ..: FOR DEDUCTION FROM ASSESSED VALUATION I
t Gibson `� `.022
State Form 43709(R14/1-2J)
1-, j Prescribed bj Department of Local Government Finance —
�--`"` File Mark
INSTRUCTIONS: To be fled in person or by mail.
Form filed W i:h
Filing Date Form mist be completed and dated in the calenda-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
located on or before January 5 of the calendar year in which the property taxes are first due and payable. ` County Recorder
See reverse side for additional instructions and qualifications
goo'- n•(Cane'o•contrad buy ee restrictions cr reverse s de)
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_ =_rue o'rear p'c_ c' f.o.,_=_ge.Co,,a:t I-r.e _u .r ,as.. I to-gam_I Conye_t indebted-ass u-pa d as o` Is the anpFcant we sore
As-- _
assess—._r;date ccr.art lea' t"=_:'
as assessment data curvent yea• i date o`z ,. en lega'o'eGui[�ab�+e o�..ner?
/x� c' C No
I`owned with sd�..eone oche-tha spouse indicate v::h whom
If ro what is h s!he'exact state of inte-est? I P
If name on reco•d is d5=rent tea-that of app':cant ir.,•c..a be'os I Is the. pe.y i ques`on Annually Assessed
Peal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
i N3m=¢`r:oo/:g�a_�ea/c�•con:'actl s=" //Q / n, , �/ i
Ad.. s-of rot ganee •contra.+s "e-(runt and street ctty state.and ZIP coda' CC
(1:21- O
'Name c`assignee o-other ov.ner o' .. _--- - - -sad- 0
Drawer NO �0.(. N a
Address of ass'g'ee(r.umter arid s' i F
p T'!,y i a- Card NO. , 0 v .de&•cGo _en re-quested I I`yes.state zmo'�;,,p,f duct; V
Does app4an:,:: �'�1
other count/ r� t ND arty ffor Yes No I Q i
I in Ind'are? _ TA - 'on h: ye," i _ O
A person is not entitled to this d_ ` fha ;age or c n act indebtedness that is recor he county m
recorder's office(including any equity line of credit t is recorded in the county re�_:r's office th is the basis for the on. f7
`/�\ COUNTY AUDIT014-
--
Deduction aop'oved in the amount cf i
20 T-20 20 i 20 20 i 20 20
J
,. Ccun'.y Date(month i year;
S:One:u'e f aunty AJ �t0`
n We certify under the penalty of perjury that the above and foregoing i r ation is true and correct and that the applicant i are-:der, of Indiana and
X.........,owner I contract buyer of the afore. entioned property on date appl�ca. is filed natu- low,e•-'s fur'nerve)- - _ •Date(month day ysar)
F;,"r=sd=_ address of a2ii,-tort(ru^t_= c.d trine: :y state -.d IP cede ,C.y/
Fe's n aJt` nze_bi d`�'7 e_ex .u:ed PowerAttorney
o or b1 IC 6- 1-12-0 7 i Date(month.day year;
I
I
Address or autho zed person (number and street.cry state.and ZIP code'
The penett:es for perjury can include imprisonment up to two and a half years and a fine not to exceed510.000