HomeMy WebLinkAboutMortgage_Lewis (8) d,s,. R,r.4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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",„A. FOR DEDUCTION FROM ASSESSED VALUATION n //�i�\ /
State Form 43709(R14/1-20) 2022_
_-✓ 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. 'County Auditor
Must be filed or postmarked with the County
A nt(owner or contract buyer-see r slricti� rs
ons on re verse side)
\Vt� lei�� ` ' ` Ste` C, l-N Record number Page number
Taxing District K y number/le al de np \ R 2 ---0 O-N� ^
Assessed value of real property as of Mo ea/ act' de of ort in ebtedness unpai of Is the a li t the sole
le al or itable owner?
assessment date,current year a s i
c ate f cat ° 0 9 ❑es No
If no what is his/her exact share of interest? If d wi s e o r t an spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is a property in question:Annually Assessed
Real Property ❑Annually Assessed
FIL
ED Mobile Home(IC 6-1.I-7)
Name o rtga ee orcontract sells { \ 1.�L`
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) J U N 0 2 2022
Name of assignee or other owner or holder of mortgage
4thzall tGe &. J--,a)
Address of assignee(number and street,city,state,and ZIP code) GIBSON COUNTY AUDITOR
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county ❑ on property for ❑Yes ❑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 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 C my udito County ` Date(rill!y�@r)Z
under •
the of perjury that the above and foregoing information is tau and correct and that the applicant is ti resident of Indiana and
I/We certify ty ' 1
X
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name) Date(month,day,year)
�
Full residentaddre appN�nt(num013\ street,city,state, ZI0 ---ode `^ k±1 1
Person authorized by duly executed Power of 4&tto�rne�y or rb'yy IC 6-1.1-12-0.7 ,r ` Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
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