HomeMy WebLinkAboutMortgage_Gottman (2) ,,!7 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS founty Township Year
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FOR DEDUCTION FROM ASSESSED VALUATION rn� c � "J
i} State Form 43709(R14/1-20) V JQ1) OZ ' 2Q(f—
ti---- Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail.
Fo m d 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 contr ct buyer-see restrictions on reverse side)
Pvin.N- . ME/I A .l7 C# -
Taxin.g C strict Key number/legal description Record number Pag numb
ir�tj�Cr/t- Grt_ 26-i6- ��_ 20 D4r,-VSfIn.ZI 2�
Assessed valu of sal property s of Mortgage/Contract indebtedness unpai as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment dat current y r assessment date,current year date of application�� legal or equitable wner?
No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom ll1�'•T G�
If name on record is different than that of applicant,indicate below: Is the rty in question:Annually Assessed
eal Property ❑Annually Assessed
0. \
(�//� Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract sells F r-4-k Tkt.d' ���1� ruAddress of mortgagee or contract seller(number and street,ci I {� r7 C tC3G ! '-k`f v arFILED
c J
Name of assignee or other owner or holder of mortgage
l�.1\ J (3 `\(\w-cN MAY 2 5 2022
Address of assignee(number and street,city,state,and ZIP c 1
c)4l-0130 9
Does applicant own property in any If yes,what county? What Taxing District? nab uub ,d �an itat fAtia![Rt�✓
other county Ion property for GIBSON COUNTY AUDITOR
in Indiana? El Yes ❑No current year'? `�py(��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 year
20 20 20 20 20
Signature of County Auditor County Date(month,da
( J/f eji rLaA0 � (J'l l� y,,5��2 J 4-,/2/�2102 21
I/We certify under the penalty o perjury that the ab e and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned propert n date application is filed.
V'gnet er's II nam9)` Date(month,day,year)
Full resident dress of applicant(number and sir ity,state,and ZIP de)
7.5 93 r►i' 25--. Ls'
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 nari,os,ran innlnde imprisonment LID to two and a half years and a fine not to exceed$10,000.