HomeMy WebLinkAboutMortgage_Roudebush (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�� , A FOR DEDUState Form 43709 CTIONS FROM ASSESSED VALUATION
'4 ` � Prescribed by Department of Local Government
year. ounty Recorder
2) Mobile/Manufactured 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 is sought
See reverse side for additional instructions and qualifications.
Applinown contract buyer(,Stge�rstricyons��side)
Taxin Distri `\ Key~number/legal des 'ptfbn tvoo Record num r Pag umber
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage Contract indebtedness uyyy&&&aidas of Is the applicant the sole
assessment date,current year assessment date,current year date of li�tiV► Q W legal r e. '-.le owner?
�( /I Yes 0 No
If no,what is his/her exact share of interest? If owned with so Wile other tan/spouse,indicate with whom
If name on record is different F a f"•T pli in '.-. e property in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller]E C 1 6 2019 U 19
NO
Address of mortgagee or contract sell number d s ' ,state Drawer
Name of assignee or other 61f)tldl YgAuulTOR, Card NO.
Address of assignee(number and street,city,state,and ZiP code) , , O/6 _
�21
Does applicant own property in any If yes,what county? 1 equested If yes,state amount of deduction
other county
in Indiana? ❑Yes ❑No I i.a„....,...... .--. .—_ ❑No
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 AUDITOR
Deduction approved in the amount of:
20 '+i 20 20 • 20 ' 20' 20
Signature of County Auditor 4 (/ jy )
} County \irk
< �� Date(mo t
Iyear)6 (
I/We certify under the penalty of perjury t abo)w�dd foregoing information i� and correct and that the applicant\s adent f Indiana and
owner/contract buyer of Jhe aforementioned property on date application is filed.
ature.r ler sfup t!nor Date(month,day,year)
7
rul rete•re8of ap can (nu et city state and ZiP code)
,. �.� nJtm ,
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,