HomeMy WebLinkAboutMortgage_Huston . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
' _ I. FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15)
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.
Applicant(o ner ntract bu r-see res 'di on reverse s' )
Taxing District Key number/leael des«:.ion Record number Page number
Assessed value of real property as of Mortgage 1 Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessmentdate,current year assessment date,current year date of application legal or equitable owner?
07G tJ�0 0 Yes El No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is th roperty in question:Annually Assessed
) epaI
Property 0 Annually Assessed
�� Mobile Home(IC ti-1.1 7)
Name of mortgagee or contract seller( )4e ' /��,%/ `7�'�,0 _
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) pi- `�
Name of assignee — _i
v 02,0 _ 0 c 0 S. JAN .�, 2020
Address of assigns
Gl . . I
Does applicant ow r What Taxing District? e Na ''€€II�►r,k j��.?' equested If yes,state amount of deduction
other county DrawerNO on
?�' I in Indiana? L current ye r 71 Yes ❑No
A person is note 1 has a balance on the person's mortgage or contract 1'cfbtedness that is recorded in the county ,'
recorder's office Card NO. sat is recorded in the county recorder's office)that is the basis for the deduction.
' COUNTY AUDITOR
Deduction approved in the amount of:
20 / 20 20 20 • 20 ' 20' 20
Signature of`Ili,'
ii'Auditor _ County Date(month,day,year)
i
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 aforeme tioned property on date application is filed.
s.f.,Signature(o s full na Date(month,day,year)
1/ '7 W
Full nt dr of li nt( mbar and t state,a IP code
z# a v
Person authorized by duly executed Power of Attorney or by IC 6- .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.