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HomeMy WebLinkAboutMortgage_Powers (6) 4.^yr: STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS — 'County j Township Year 44:i4 FOR DEDUCTION FROM ASSESSED VALUATION State Form 4370e(R,,/1-2.3) Gibson © ZA , o 22 . • Prescribed by Department of Local Government Finance . File Mark INSTRUCTIONS: To be filed in person or by mail. Form filed 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 rty is County Auditor located on or before January 5 of the calendar year in which the property taxes are first due and payable. Li County Recorder See reverse side for additional instructions and qualifications •Alp^'an'(o:.rr or b^y-r-s bons cr reverse side) Tax fro D'sro• I�y number I lace' escriptior I Record number Page number C-11— 1—� —O 0 1 y _l0 0 1 Assessed a ue c re--prone- t'o�_a3e i Contract ind- :edre-s unca-as dI drubdt indebtedness u^ a - ass _ri date.'currant yea? ass�sment date curre-a yea _ y'��.=,� o Ja'd s o• Is ee'or i'cart the sots'. c a (XJ Yes C No If ro what is h s I her exact share 0`interest? l'-stoned with someone othetthan spouse indicate w'ih whom 1\ If name on record is dfferent than that of app'icant ind-_ats be'o.: I the grope ty-in queston Annua'!y Assessed ! 'Real Property ❑Annually Assessed ____ lie Home(IC 6-1.1-7) Name o• .y .,scat. Address of neon.;agee or contract s_'1^_r(r•t _.--_- __or other owner or ho'd= -__--_.-- --- 4 ��..I ha-re -- Drawer 1\fO... �. 1 .. MAY / ..r. Add_ss Mf ass._r'_e in:;mter and s'.reei. ^ •• r be c Q a ♦ ,. —_--_I n Card NO ( OJTw i� TYJ/YY ��,AUDITOR Do-es app.r_ant o:: prorr orty in any l' '-• Jun • - I -yes -Go, ,u.a:_d L- state amount of deduction othercruna E for es ❑No ! ._n In .ara? Eves I No i A person is not entitled to this deduction unless the person has a ba'ance on the person s mu<<yoyz•or c nt ct 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 — ------ • Dedcct.on approved in the amount cf I i - — I 20 20 20 20 20 20 20 �JI Signature Monty !itor 1 Cc^nty \ O� Dare(. nth,I � 7�`1 vz-,-__.-- II We cert7fy under the Fena't Jury that the above and foregoing information is tru a .d correct and that the applicant is a resident of Ind;ana and owner/contract buyer of the aforementioned property on date apptcation is filed. Xre lori�e rs.ur,r�rns)- 'Date(m day�_20 z-• dip F�r= •a'•'♦1 o`.a_'Ii,.ar:(rumaer and street c"7 stare ^d ZlP c X S� �,.� $c�0 S D1 vc 1\e- an- � 6 Person a_dnorzed by duty=_x=_outed Plover-or Otto-re,cr b/IC 6-1 1-12-0 7 !Date(mcn th day year; i I Address or aut^o^:zed person (number and street.city stats.and ZIP code; T . . n ,ies for.era• can include imprisonment up to two and a haft'years and a fine not to exceed 5f0.000