HomeMy WebLinkAboutMortgage_Higginson (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
At-'?--Et;, — County j Township I Year i
'.- £ FOR DEDUCTION FROM ASSESSED VALUATION
S:a.e Form 43709(R147 i-23j Gibson n vt Y n )2�'
. `f Prescribed by Department of Local Government Finance — -` �/•J
_-- File Mark
INSTRUCTIONS: To be fled in person or by mail.
Form Fed v;lth-
y A 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 !
located on or before January 5 of the calendar year in tohich the property taxes are first due and payable. ! CountyCount Re udcorderitor
See reverse side for additional instructions and qualifications
-A2 7iCa (c:.n/e�-cr contra-_t brier tions cr r ieroa s;de /' �� ,,�-y� Re::
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Assessed'ra u=of read pro a-c 1:'or._=_ga i Ce:bay.ind2,.._dneos.mpa -s o I�1o�ga,e/Centre_ .c_...ed _ss u-pa"d as of Is the aopl, art the sae_
assess,ent date.corr- r:yea" assessment date CU^Ent y'ea- da:e Of aeo' zt:on legs' 'e citable crane'?
(_No
'If ro v:`•a'is h s!her exact share o`interest? If cv:red:cith someone o:ne-t an spouse.indicate yr to whom
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If name on record is d`ferent than that of agy cant ire r_Ie be'o:: I .e property'in ques''on Annua'ly Assessed
I. !Real Property ❑Annually Assessed
_ Mobile Home(IC 6-1.1-7)
Nam- `mortgagee or contract
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A dr- s of mart; contract conE.a s_. (r 'street.city ._.and ZI codai -- -- —_ ,_
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'N 3-re C`2S5'gn29 or O!h2.OV.her Or ha•d%"cf rr' •nra —�-
F.dd'-ss cf ass•g^ee plumber and s"eet.Cat.7 7� �/1/(*"�: `.. ------ --' Z
Does app ant o:.n p.o;_'1 in -:y I`yea :. Drawer 1\7�...3-�:?l. .1... —:b - ed I I`yes.state amou'd :uctortd I Z
other county s - No l i
in trd zra? ❑Yell �I No i � y� ' r r���.F to
A person is not entitled tEthis deduction e t 11. y� _.o 7n a.y'n dness that is recorded in the county
recorder's office(including any home equ Cat �T�• 4�� (;J th t is he b sis for the deduction. y O
D educbco aopro•n_d in the arrow cf {
20 20 1 20 20 20 20 20
S:c 'County wine' --- -_ Ce_ i Date(.rent,- y year)
I f We ce fy under the penalty of perjury that the above and fore • in ormaton is true and correct and that the appfcant• a reside of Indiana and
owne c rtract buyer of t e aforementioned property on date ppl'. tion is filed.
S.g-`a' -e I ;na's`, I Date(rr•or,t day yea-)
FL.'r25.d2^.'a'''r==;c`•=- t}y=r' r ..be•arc.5'r_=t c•. st :- end ZIP .5
e-s:n a_ or•z_d by duly executed Power of ::o•r•ey or by IC 6--I 1-12-r'7 ;Date(month day y=_are
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Address of authorized person (number and street.city state.and ZIP code-:
The penalties for perjury can include imprisonment up to two and a halt years and a fine not to exceed S10.000