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HomeMy WebLinkAboutMortgage_Bailey (11) .. ^-'x STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year y.. .- `ch•% FOR DEDUCTION FROM ASSESSED VALUATION l Z a•- . ',7 1 :1,3` State Form 43709(R14/1-20) ©06 '?3 '+.�_.�d" Prescribed by Department of Local Government Finance F T File Mark INSTRUCTIONS: To be filed in person or by mail. 1 Form iled with: Filing Date: Form must be completed and dated in the calendar year for which the deduction is s ����fj �1] County Auditor Must be filed or postmarked with the County Auditor or County Recorder of the coup bdfierik tl�!Warty is ❑��� County Recorder located on or before January 5 of the calendar year in which the property taxes are first due and payable. See reverse side for additional instructions and qualifications. /7`2 a 7z4/ Applicant(O neyv ror contra�t bu ear-fee�ra'sti • o7verse eide) GIBSON GCJUNTY AUDITOR Taxing D`Jis`t i`c��t`J_V'W^4 �Ke n mber/legaal s �ptien Record number Page number©� - �-13 --��- zoo-ool 3 6^o o G_ v a �- As sse af rea property as of (((Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole assessment date,current year I assessment date,current year date of application legal or ble owner? . --.0 Q o Yes ❑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: I t property in question:Annually Assessed Real Property El Annually Assessed � Mobile Home(IC 6-1.1-7) il Name of mortgagee or contras Iler ' 7}�/LY slEvE *J" Address of mortgagee or contract seller(number and street,city,state,and ZIP code) _ t T L.I . Lyfu Ai Name of assignee or other owner or holder of mortgage /A/t ���JJJ Address of assignee(number and street,city,state,and ZIP code) i/ /`� dW,,1n Does applicant own property,in5by If yes,what county? What Taxing District? Has tr i other county on properly for Yes U No in Indiana? ❑Yes No current year? A person is not entitled to this deduction unless the person has a balance on the person's mortgage or on act 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 Signatur f C n di60 rt: n $farj113 County l` Date c r,O year)),OVz- > I/We certify under the penalty of perj M�ticythat the above and foregoing information is t u and correct and that the applicant i a resident of Indiana and owner/contract buyer of the aforementioned properj� date application is filed. C gnature(owner's full name) ,^„, ^0 1'/ CI Date(m day, e^r) z z , Y I/1lW bJll•���J Ivn�LJ \` S [O V Full resident address addresss of applicant(numbber and fret,city, ate, nnil ZIP code) r. Person authorized by duly executed Porter tuff Attorney1` or by IC 6-1.1 -0.7 `olt,\ 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.