HomeMy WebLinkAboutMortgage_Kunce STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
. Fi
: s FOR DEDUCTION FROM ASSESSED VALUATION
� -T_ *. State Form 43709(R13110-15) S l� .etrt(�r) to l�
Ste/ �1 y�
,,,, Presrxrbed by Departrrrent of Local Government Finance -
File Mark
INSTRUCTIONS:
To be fled in person or by mail. Form filed with:
Filing Dates 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile IManufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
• where the property is located during the twelve(12)months before March 31 of each year the deduction Ls sought
See reverse side for additional instructions and qualifications.
Apo•wt(owneryr con on reverse side)
affw,t@,(n r- Yc.cq \te k\&,'\ c
�arnry —al .r�,,t .9 — �- -la l -oo0. IQ -02C . Record
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Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage d indebtedness unwid as of Is the applicant the sole
assessment data,aurerd year assessment date,anent year date of W legal or itable o+meR
� � � Yes 0 No
If no.what is his/her exact share of interest? If owned with so ne other thaA spouse,indicate with whom ,��� \\\
If name on record is dherent than that of applicant,indicate below: the property in question:Annually Assessed
/p Real Property 0 Annua(IyAssessed
• // �� Mobile Home(IC 6-1:1-7)
Name of mores rtra filler r izokin ik . I� — 5
Address of mortgagee or contact seller(nand street city,state,and ZIP co V Jr - -
Drawer NO.. .. .....
Name of assignee or other owner or holder of mortgage ••••••'
Address of assignee(number and street,city state,and ZIP code) a) NO. ........ .............
•
Does applicant own property in any If yes,what county? What Taxing District? Has tms oeauw.., as,state amount of deduction
other Indiana?diaanna?y ❑Yes ❑No I=rent year?properly for Dyes ONo
A person is not entitled to this deduction unless the person has a balance on the person's 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 AUD IL
44
Deduction approved in the amount of: I�/
20 20 1 010
2020 - AU$ 1 9 2019 ' 20• ` a(�20
Sgnature of NmAtiICountyAfiatir Date •�aY• 1I/We certifyunder the naJ'ofl` n (_,`pe ny perjury that the above and foregoing infomlatgj�(gpy1Q.(�Ci1leZ;t3dtlls9lll(�E�pplicant i acres' ent of Intliana and
owner I contract buyer of the aforementioned property on date application is filed.
X Signature(av0efs full name) 1;�r1W IV �Y Y1af\l/( ? tr .
�7t(
I
Full • tad of t(nu d street Fity,state,and ZIP code)
Pe authorized by duty d 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 Iwo and a half years and a fine not to exceed S10,000.