HomeMy WebLinkAboutMortgage_Graper (3) STATEMENT OF MORTGAGE OR CONTRAc IND D County Township Year
�� FOR DEDUCTION FROM ASSESSED VALUATION /
ar�Son V a
� � State Form 43709(R14/1-20) AUGAU G 2 6 2022 `�
* � Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail. '`may A.,...e a ' a Form filed with:
Filing Date: Form must be completed and dated in the calendar year alafilaiNt ellilA /ShoA4,9®PP04 County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property 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.
Applicant(owner or contrac buy see restrictions on reverse side)
J )(Dnc`l� PPs - -4-- Li s o_ L. 6 raper-
TaxingKey number/legal description Record number Py'3Cq umber
District Y g ? ,R S ZZ Jq t
Unia� �-► -o3-aoo - coo, o -o J
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is s the applicant
the
e sole-
assessment date,current year assessment date,current year date of application 9equitable
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:
Is the property in question:Annually Assessed
II-R'eal Property ❑Annually Assessed
ome(IC 6-1.1-7)
Name of mortgagee or contract seller F I L ED
.S'>P►-;tn 4 Vonite v cs,,t_ l s--
Address of mordigagee or contract eller(number and street,city,state.and ZIP code)
it AUG 2 6 2022
Name of an.innoe -- --- . " - �'(�
Address o -� (�.lA..e..e a A
g District? Has this deduction been r ested If yes,state amount of deduction
Does appl �f\ \ GIBSON COUNTY AUDITOR
on property for
other cour V�in Indiana' current year? s ❑No
A person eon the person's mortgage or contract indebtedness that is recorded in the county
recorder's �� i in the county recorder's office)that is the basis for the deduction.
� /f` DUNTY AUDITOR
Deduction ,( \ (3( \�•\
20 \J\ 20 20 20 I I II 20
County Date(month,day,year)
/M
Signature
ofa0-County Auditor 4/ , (� .3.,-‘ b/.a-(f!/a
'1e1.. � h'
I/We erti u der
the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
?Are co tra t buyer of the aforementioned property on date application is filed.
Date(month,day,year)
Snafur w rs ll name)
I.,,r i e t d ess of applicant(number and street,city,state,and ZIP code)
87 5 35--- -Pc",nC.e -O rl "TA/ 1/76 7 D
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 perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.