HomeMy WebLinkAboutMortgage_Hardiman (9) ,�\a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cory Township Year
FOR DEDUCTION FROM ASSESSED VALUATION l
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� State Form 43709(R14/1-20) � .,�' 1 02�
e�-.0. Prescribed by Department of Local Government Finance
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
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Assessed value of real property as of Mortgage/ ontract indebtedness unpaid as of Mortgag /Contract indebtedness unpaid as of Is the a plic t the sole
assessment date,current year assessm date,current year date of plipajiQn^ ^ 0 0 legal or qu" ble owner?
\t•(\S 9`/' es ❑No
If no,what is his/her exact share of interest? If owned with so Bone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: I{th property in question:Annually Assessed
Real Property ❑Annually Assessed
FILE,D
Mobile Home(IC 6-1.1-7)
1 Name of�s+e tgagee or contraseller
Address ofm gage .--. contract V seller(numb street,city,state,and ZIP code)
DEC 3 0 2022
Name of assignee or other owner or holder
of mortgage �'] �j
Add / / /� n!/, 4/" / /7LC�lLC Y AUDITOR
R
t// J GIBSON COUNTY AUDITOR
Dof �`�/!��-' ) What Taxing District? Has this deductio be requested If yes,state amount of deduction
in I Si „5. on property for
in I L( current year'? Yes ❑No
A p 1
Al
'/USE na1 is a balance ont the person's mortgage or nt Ft indebtedness that is recorded in the county
rec. y/�� /' is recorded in the county recorder'
s office)that is the basis for the deduction.
(/l/ 0 A _ I- COUNTY AUDITOR
20 20 20 20 20 20 20
Signature of ountyA 'or l-t _ /� County l Date(mo h,day, ar)
1✓I� )Vc l Jf SUS Z 2I. 2a7e-
I/We certify under the penalty of perjury tha a above and foregoing information is tr a and correct and that the applicant i a resi ent of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
XSig re(owner's full
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L M /�Yc.AEI✓ Da�(mo h,day, �2 ( '
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ull resident address of apw"can (number and street,city,state,and ZIP code) l((/
12 2 0 rt t-e- ,M vc
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 imorisnnmant,,n in tn.an=n.f=i,=if,.==r,=n.f=fin=nni in=vnaarf Tin non