HomeMy WebLinkAboutMortgage_Gladish (2) .x*.!!!n4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
A . \t FOR DEDUCTION FROM ASSESSED VALUATION -^
State Form 43709(R14/1-20) ��Y I 0 22 2i< 02�
,,S , Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail.
Form£ed 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.
l
Applicant( ner or contr uyer-s e rctio, • reverfe_sid6
1K\ '� ne dn. • lNJ1�
Taxing District.) Key numb 44 legal/description` ��"`-1 O l° f S-ei _ Rp orcnumber_,o P u
Assessed value of real property as of Mortgage/COact indebtedness unpaid as of Mort ge/Con ct in¢¢¢ggqbteye�Euxpaid as of Is the a pl. nt he sole
assessment date,current year assessment date,current year dat on P 1 /�\ 1\/1 legal or uitable owner?
`�l� v Yes ❑No
If no,what is his/her exact share of interest? If ownedwnE wit someone othe/than spouse,indicate with whom
1 If name on record is different than that of applicant,indicate below: e property in question:Annually Assessed
f Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of me�rtgayee6r cont seller JUN 2 9 2022
Address of mortgageeV\\ or co act seller(number and street,city.state,and ZIP code -_' ��•�/'
Name of assignee or other owner c �'N CO AUDITOR
Address of assignee(number and
Does applicant own property in ar Has this deductio b grequested If yes,state amount of deduction
other county D1 ati1'C1- No•• 06 on property for
in Indiana? ❑Yes ❑N •, •••• current year? Yes ❑No
A person is not entitled to this ////���� pn's mortgage or n act indebtedness that is recorded in the county
recorder's office(including an Ca I'd No. • ��g. /recorder's office tha is the basis for the deduction.
TOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of C Audi (D County (/\ Date gin7ctar \
II/We certify under the penalty of perju - •e above and foregoing information is true nd correct and that the applicant is resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature ner's full name) Date(month,day,year)
Fu a ident address of applies (number /d streg star,a(rd�ZlP code)
Person authorized by duly executed Power of Attorney or b}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 perjury can include imprisonment un to two and a half years and a fine net rr,ev.-ee.+e+n inn