HomeMy WebLinkAboutMortgage_Gottman STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
��� runty Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15)
_ �p 20�q.
,_„
C- . Prescribed by Department of Local Government Finance
INSTRUCTIONS: • File Mark
To be filed 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/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.
Ap nt`a e\or contra bu es% ' on reverse
T "n District 1 Keynumber/le aldescri description
9 9 P Record number Page..umber
Vile n� 6- 0 z6- 2,(9o-oV n . n — 0 V • 7_0 ( 2,�`
Assessed value of real property as of Mortgage!Contract indebtedness unpaid as of Mortgage!Contract indebtedness unpaid as of Is the applicant the sole
assessmentdate,current year assessment date,current year date of pplication legal or e able owner?
, Yes ❑ No
If no,what is his/her exact share of interest? If owned with s ebne other than spouse,indicate with whom
If name on record is differ - - — --- I property in question:Annually Assessed
Real Property 0 MobileAnnuallylame(IC d
)� Mobile Home(IC 6-1.1-7)
Name of mortgagee or co Drawer NO _
Address of mortgagee or FILE' -(R
Card NO.
Name of assigneeorothe JAN 0 2 2020
Address of assignee(number and street,city,state,and ZIP code)
. I
Does applicant own property in any If yes,what county? What Taxing District? G I BliatiiiaglilWilialietWillitiTsgoR If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes Ell No current year? ❑Yes 0 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.
2 20 d_iii.:1 20 . 20 ' 20' 20
Signature C n Audits kick
County . \ Date(month,da ear)
YA
OJ - ° - p —c -2c7
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 filed.
Tture(swrp
r' ) Date(month,day,year)
•
sidentaddressi (n`Oand s fret�rty NNANZIP—code)on — L\96 Gs-
Person
authorized by duly executed Power of Attam`ey 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 S10.000.