HomeMy WebLinkAboutMortgage_Robison 4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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FOR DEDUCTION FROM ASSESSED VALUATIONtb �Owo �a
)• State Form 43709(R14/1-20)Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail. Form fit 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 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.
N� A- Re be C a+K�'
Keynumber/legal description Record numberr'�^'� Page number
Taxing District c2 o� 1/ 3
�c��o .,-Ashtc a�-Il i 3- as-ocx� lid - 0� 7 nt the
Assessed value of real property as of Mortgage/ c in tedness unpaid as of date f Mortgage/ ct indebtedness unpaid as of Is the
equctable owner?
assessment date,current year assess ratOe,f.}irrent ear
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
Is the property in question:Annually Assessed
If name on record is different than that of applicant,indicate below: ( 1-F(eal Property ❑Annually Assessed
Name of mortgagee or contract seller .
FILED Mobile Home(IC 6-1.1-7)
An C)(—
Address of mortgagee or contract set' • 0 C T 2 4 2022
Name of assignee or other owner or •
Drawer NO 4o4, — �h��f a...� >�
Address of assignee(number and sl / GIBSON COUNTY AUDITOR
Does applicant own property in an Card N1 O. 16,32. Has this deduction been requested If yes,state amount of deduction
on property for r-t"� No
other county ❑Yes No current year? EiL' s
in Indiana?
A person is not entitled to this ch..—........_...-_ :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 I 20 I 20 I 20 i 20 I 20
nI \ v I County Date(month,day,
year)
/J 1l
Signature of Co/ k•&4 \N Auditor ` (—�*_ 1 V.J 0 Y>, J(//�'`%,(-)-c
I/We certify under the penalty off\perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed. Date(month,day,year)
Si 40 ufe(owner's full name) — cola sf//��
Ful resident addresst41 of�licant number and st,1-4491 v e—ci`y,state,and ZIP code)
CQ 4/ 1 Vj �.r IL A e V(--.,r\c e.{oY) 1-Ai L/7&7 U
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.