HomeMy WebLinkAboutMortgage_Gonzales (3) • STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�� FOR DEDUCTION FROM ASSESSED VALUATION • ^�.+•�
State Form 43709(R14/1-20) G t)5o n 1 I nGe„'/1 . ,a
Prescribed by Department of Local Government Finance
Fde Math
INSTRUCTIONS: To be filed in person or by mail Form fled odic
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. L' '"-- , Auditor
Must be filed or postmarked with the County
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-pc At..4 bra rl b-,a-Is-3ot-on/. Cod I -Oa 8 • fig- "LteL
Assessed value of real property as of ithalo tpe/Contract indebtedness unpaid as of I____ III or el4 Mthe
assessment dab,current year eesssen.id dale,current year
as gas ram•• 0No
If no,what is let/her exact stare of interest? If owned with comers other has spouse,indicate with whom
If nerve on record is dAterent than that of applicant.indicate below_ Is f»property in axfefort Mousey/ieseseed
CBAial Property 0 AnnueSy Assessed
Stable Horne(IC 6-1.1-7)
S Aran j vulfry 13an1< z(' i r,r3 t- --FILED
Address of mortgagee or contract seller(number end street cty state,and ZIP code)
Near of assignee or other owner or holder of mortgage DEC 3 0 2022
Address Of assignee(number and stw&city state,and ZIP cods)
if yes.what county? I What Taxing District? Has this deduction oeerr+epwv nryes:sox aMatt d.dueeon
(]Yes Girok, t on,Tr tree o No ,
A person is not entitled to this deduction unless the person hes a balance on the person's mortgage Or contract Indefilledness that is recorded in the county
recorder's office(including any home equity kne of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in Me rimmed:
20 20 20 n 20 20 20 20
J r y. -- (%�"r""' Dale(fnonOt,del:year)
Siiga4srs of County Auditor ,^Vd\
I/We certify under the penalty of 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 lied.
Fat resident address of appera*lnw�a eat.cry.afee.and ZIP aodr _
53r U3 L1 10:.ne A.1e• :vn -e.4rovw 1-Ai Li-1 & 7 0
Person authorized by duly executed Paver of Memory r orM 6-1.1-12-0.7 Dale(month,day,wirer)
Address of authorized person f nwnber and street,city-state.and ZIP code)
1
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.