HomeMy WebLinkAboutMortgage_Dyer (2) ►. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
��`'n t. FOR DEDUCTION FROM ASSESSED VALUATION
�i . .... P1 6 .
State Form 43709(R13/10.15) ,/
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.
Applican owr r or contra r-see restrictions on reverse side)
n' e.A •
Taxing Key number/legal description Re numbe Page numb
2b -1 1 -I 2. - t0 3-000. g3s�--�LB 7 oco
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage!Contract indebtedness unpaid as of Is the ppli nt the sole
assessmentdate,current year assessment date,current year date(/1`o Ica ti® legal o e itable owner?
Yes El No
If no,what is his/her exact share of interest? If owned with someonIother than spouse,indicate with whom
If name on record is differentthan that of applicant,indicate below: s e property in question:Annually Assessed
Real Property 0 AnnuallyAssessed
' Mobile Home(IC 6-1.1-7)_
Name of ages or n Her (�
1 "reci &'- t-.‘ l< .
Address o mo gagee or contract se er(number and street city,state,and iP code) Ft .
, . ,
_ , __.
Name of assignee or other owner or holder of mortgage
.pN 0.3 2020
Address of assignee(number and street;city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? deductiontieen requ ted If yes,state amount of deduction
other county ��(y
in Indiana? ❑Yes ❑No GIBS rar ' 0Ye's 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 gla 20 20 20 20 ' 20' 20
Signature of Coy editor cv, County Date++ onth
I/We certify`ceder the penalty of perjury that the above and foregoing information is true and correct and that the applica t is- resident of Indiana and
owner!contract buyer of the aforementioned property on date application is filed.
XSigna e(o er's fu ame) Date lolly,ys�r)D
Full resident add
of appli (num nd street,city,state and ZLP code) ` CC//�-
943.7.0
•
Person authorized by duly executed Po of Attorney or by iC 6-1.1-1 7 t Date(rfeo th„d ,yea
Address of authorized person (number and street,city,state,and ZIP code) 1 S [J—
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.