HomeMy WebLinkAboutMortgage_Gore STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
a,' , FOR DEDUCTION FROM ASSESSED VALUATION
7' Q 2�
'\1 � State Form 43709(R14/1-20) i
;. Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be tiled in person or by mail. F m d 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
Ap t(owneerr or contract buyer-see rest'ctions on reverse side)
\ t(to, `c/l.S Record number Page number
Taxing/District�� r ey number.:l description 4 ^ O-^r'""1 -S �^ 2- 2,
r> r P 0
0
Assessedvalue of real property as of (' Mortgage//CConttraactct indebtedness unpaidv asas Jof Mortgage/Contractv indebtedness unpaid as of G_Is tal ap(pl_ictablnt te the
sowole
assessment date,current year assessment date,current year date offcat l Ni a 0 9 quitable
/IV V Yes ❑No
If no,what is his/her exact share of interest? If o
wnedwith soe other tharn spouse,indicate with whom
i F-y D I e property in question:Annually Assessed
If name on record is different than that of applicant,indicate below: 1 ■
eal Property Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller O C T 2 6 2022
Address mortgagee or Zontract seller(number and street,city,state,and ZIP code) 14
Name of assignee or other, ..-.3VN COUNTY AUDITOR
Address of assignee(numt Dr a\V c 1- N O...QjAia
Does applicant own propel
Has this deduction n requested If yes,state amount of deduction
infherIndiana? Yes Card county NO. 43� on property for
currentpr year? Yes ❑No
ot
A person is not entitled person's mortgage or ontr ct indebtedness that is recorded in the county
recorder's office(includ county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 I 20 20 20 20
County \ Date(moo fay,yea
J
Signature of County Auditor /-� \� J (� I 1_O 2`Z
I/We certify under the penalty of perjury that the above and foregoing information i t e and correct and that the applicant is residenteeeo f Inndiana and
owner/contract buyer of the aforementioned property on date application is filed.
Date(month,d4y�ear) ..
Sign ture(o ner's/ name) `\.YV1 Clt7_ L-
ull IA
resident
1addre-ss of pp�icaant(n tuber and street,city,sta`\t and ZIP code) ��.�
A0l4 VJ "� J4c /"1 v`me —�� /6 , Date(month,day,year)
erson authorized by duly executed Power of Attdrney or by IC 6-1.1-12-0.7
Address of authorized person (number and street,city,state,and ZIP code)
The penalties for perjury can include imprisonment un fn hn"+_^.'-.'"''r..--