HomeMy WebLinkAboutMortgage_Houchins (2) ^•,► STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS �ounty Township Year
FOR DEDUCTION FROM ASSESSED VALUATION ' ^, ^n
State Form 43709(R14/1-20) `-'t (/z ,,
, ,,, .r" Prescribed by Department of Local Government Finance
4File Mark
INSTRUCTIONS: To be filed in person or by mail. g
with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. unty Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is unty Recorder
located on or before January 5 of the calendar year in which the property taus are first due and payable.
See reverse side for additional instructions and qualifications.
Applicant wner or contract buy ,e restrictions on rse side
e . Ball
Taxing Dis e u b=legal descris(iorl, �� Record numbs Pa e n ber
g 4 — 000. t 2--0� �o � ' SI
Assessed value o�real property as of Mortgage/Contract indebtedness unpaid as of Mo age/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year da f aprllFa�ipn ^ f legal or qu ble owner?
U (v\U Yes ❑No
If no,what is his/her exact share of interest? If owned wi some n othe(than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: t property in question:Annually Assessed
Real Property ❑Annual! Assessed
mo gee or cont seller ILE.
0 0,
Address of mortgagee or co ct seller(number and street,city,state,and ZIP code)
APR 2 9 2022
Name of assignee or other owner or holder'
Address of assignee(number and street,cit
A4 C/Y GIBSON COUNTY AUDITOR
Does applicant own property in any If yet 3n e n requested If yes,state amount of deduction
rIndsanaoun?ty ❑Yes ❑No es ❑No
Indi />
A person is not entitled to this deductiot o?Ovt�-A / •o t ct indebtedness that is recorded in the county
recorder's office(including any home et that is the basis for the deduction.
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of Cmity Au¢i or , ' n County ` Date(m njk,da,year) '
I/We certify under the penalty of perju hit e above and foregoing information is tr It nd correct and that the applicant i a re ident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Si nature(owner's full name}�)Y�O �'�"'dle.,„f� Date(month,day,year)
F1 u(lfl,[esJ' en of applicant(numbeca`�ndVs'treeut c city,state.and ZIP code)
l V l t. ,J —
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)
r. „a,.�tfias fnr nerinry can include imprisonment up to two and a half years and a fine not to exceed$10,000.