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HomeMy WebLinkAboutMortgage_Channell STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year t FOR DEDUCTION FROM ASSESSED VALUATION // I- r L \ ..:/ State Form 43709(R14/1-20) G/,J�n ) 3ro�l.R �� `��=%; Prescribed by Department of Local Form filed with: Filing Date: Form must be completed and dated in the calendar 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. Applicant(owner or contract buyer-see restrictions on reverse side) K;rnber/y .-6. Chan'le ll 56- - Taxing Din. Key number/legal description Record number Page number f. i3ro.•ck e9C0-if ay-a©a- COD. S/'-O. .a0/3 G3So Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole assessment date,current year assessment date,current year date of application legal or equitable owner? 14OO° 11 s ❑No If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom If name on record is different than that of applicant,indicate below: ''s the property in question:Annually Assessed --- '-`- - --'-- - �'12geal Property ❑Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller 2 0 I 3F IT LJ D me C mop-+co e V 1 1 Li■ Addr ss of mortgagee or tr seller(number and si Drawer NO //^ !�/Name of assignee or other owner or holder of mortgage `c) 3✓ C1 APR 2 2 2022 14/Card NO• YYYY / Address of assignee(number and street,city,state,and L__, /7 ',/�2 t, ) GIBSON COUNTY AUDITOR Does applicant own property in any If yes,what count Has this deduction been quested If yes,state amount of deduction other county I Ion property for in Indiana? ❑Yes [ 'Flo current year? es ❑No A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract 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 Deduction approved in the amount of: 20 20 20 20 20 20 20 Signature of CT Auditor lid `.- County ` Date(month,day,year) 1 I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and owner/contra buyer of the aforementioned property on date application is filed. Signature(own s full na Date(moot'dayyear) Full resid address of applicant(number street,city,state,and ZIP code) OS S Mal, , -1— F+• T3rrArck �N 2.17670 Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year) Address of authorized person (number and street,city,state,and ZIP code) The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.