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HomeMy WebLinkAboutMortgage_Fulk ` ,¢ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County j Township Year 3 FOR DEDUCTION FROM ASSESSED VALUATION I i • State Form 43709(R14/1-20) Gibson I (9 2� (r),..3v2Z `, /: Prescribed by Department of Local Government Finance — ---!.1.!!..---- 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 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. 1 County Recorder See reverse side.for additional instructions and qualifications. -Applicant( r, •o`contra'! (1 mot.onrr= de) Taxin_D s'r_yam ^ .f .-- ru .k ;lea-'d=_s..^ `o- '0 04 —©* i r r- - _ -•Re-crd numb>_' Pa r b=r , Assessed v=_'u=o`real F'c--' -s c`1 t.'or_=_s Con:�a�.i Irgt;.dress unpa c as o i+tortgace/C�t eat i.:d_bsed-:se.u^pa s o` Is tin=-a"p;'cant the sole assess—ert date.cur.ert yea I assessment date current yea- data •'en ^ l`\J o/( V legal o` ita�a o:•:-•:r? Yes C No 'If ro v.-hat is h s!he'exact shale o`intare_? i If owned will s n:eone othe"-than spouse indicate v:`tn whom i If name on record is daiere-'t than that of app'lc_nt i-nd•:atte be•o. j I t'a property in question Annually Assessed Real Property ❑Annually Assessed P.lobile Home(IC 6-11 -7) Name _aoraon:•ade s .= F ILED _ Add ess of rto t; __a a-contract seller(r•urt--and.s?__,.c1t/ stale.and ZIP cad.. — • AUG 2_3_2022 -- GIBSON COUNTY AUDITOR i 1 v:na'. o Tang D st-;ct, I Has th's deduction n reruesled I'yes state amount of deduction Drawer NOi on property for 1 omen:year I Yes .❑No 1 rson has a balance on the person's mortgage or ont act indebtedness that is recorded in the county Card NO. 3r di!that is recorded in the county recorder's office)tha is the basis for the deduction. COUNTY AUDITOR • 20 , 20 20 20 20 — — 2O ---1 20— -- i i S:gna:u•e o`Cou^'.,F+u9T L Cocr•,ty Data( cn:P daY, a CZ -T`Iv.Vy i �� 1 I g 24Q1 2 Iunder the penalty of erju•.—e above and foregoing information i tr a and correct and that the appticant is a reside of Indiana and j 1 We certfy u d F Y perjur I contract buyer of the aforementioned property o date application is filed. ^a:u-e(o::re•'s r%arc=) '1wT. •�Dale( or: ay Year) u'r_s-d=_^:add'ess ofap'iicar. numbe-e.-d s.reatlip slate a^d ZIP - . Person aut cr.z_d by duly executed Powe-or Attorney or bi IC 6-1 1-12-0 7 i Date(month day year; I Add'=_ss of autho'ized person (number and st'eet.city state.and ZIP cod=: i r_ - __ _ • im.risonme,nt u• to two and a half ears and a fine not to exceed S10.000