HomeMy WebLinkAboutMortgage_Andrecht (2) ��"^'�a\ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
-` 1�e FOR DEDUCTION FROM ASSESSED VALUATION
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<`#�` i' State Form 43709(R14/1-20) ,�°'n f4-
TWS 20 2,0
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„ems Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail.
Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is
located on or before January 5 of the calendar year in which the property taxes are first due and payable. ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner o contract.buyer-see re actions on reve a side)
e pre wU hdeec��- �i C��r� D��nno� I ru�l�-)-
Taxm i t`t ey n r/legal descripti n Record number Page number
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Assessed value of Ikal property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year dot,of application legal or eeqquita�bl owner?
i 122fSoo•a3 __ ❑No
If no,what is his/her exact share of interest? If owned wit!,someone other than spouse,indicate with whom i
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It name on record is different than that of applicant,indicate below: Is the operty in question:Annually Assessed
❑ eal Property D Annually Assessed i,
Mobile Home(IC 6-1.1 7)
Npme of mortgagee or contract seller 4-y ,
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A ress of mortgagee or contra sel r(num r and street,city,state, nd ZIP code) --. _,,�'`�`f y'
X (.2 C wbu pl h K) 41 Co i
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Name of ass ee or other owner or holder of mortgage JAN kit 2020 -i
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1[Address of assignee(number and stye t,city,state,and ZIP code)
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es applicant own propertyj
If yes,what county? What Taxing District? Has this dear7Ct1t§cla P& �194T,r lNt�5`-5t2tP2rfiount of deduction �I
lothercounty on property for
i in Indiana? El Yes current year? ❑Yes ❑No
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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 l
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Deduction approved in the amount of:
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i 20 20 20 20 20 20 20 i
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Signature of County Auditor J •
County \ Date(month,day,year) 1
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I/We certify under the pen1. 41.1"\I
of perjury that th• ..ve and foregoing information is a and correct and that the applicant is a resident of Indiana and I
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name) Date(month,day,year)
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Fu i address of pplic n number and street,cit state,and ZIP code)
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I Person authorized by duly exec[red P wer of Attorney or by IC 6-1.1-1 0.7 Date(month,day,year)
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Address of authorized person (number and street,city,state,and ZIP code)
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The penalties for oeriury can include imprisonment uo to two and a half years and a fine not to exceed 510.000.