HomeMy WebLinkAboutMortgage_Hofman STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Isla-; County Township Year
` fi t FOR DEDUCTION FROM ASSESSED VALUATION 1 ti
74-v7q f4,1 State Form 43709(R13/10-15) ,,n Y I J (1 �'0
. - = � V .
,.,� Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mait '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(�ergr con ct buyer-see resin '.ns<i reverse
TaxingBlst)Ct.'\ 1� Key nuyaber a'dal description Record number Pa numb r
2 3 --I\-7oO �o1 . 3-C I- 07-G 2C to 0 '�
Assessed value of real property as of Mortgage!Contract indebtedness unpaid as of Mo age!Contract indebtedhess npaid as of Is the appicant the sole
assessment date,current year assessment date,current year dat of,ap ttptr legal o uitable owner?
5? 0
0
0 , Yes ❑ No
If no,what is his/her exact share of interest? If owned with omeOne othef than spouse,indicate with whom
if name on record is different than that of applicant,indicate below: I-, e property in question:Annually Assessed
�', R ❑ AnnuallyAssessed
F '. Mobile Home(IC 6-1.1 7)
Name rtgagee or contract sell T ,
ak eA,cO—
Addres'of ortgagee or contract seller(number and street oily,state,and ZIP code) it_
�A N 2 7 2020
Name of assignee
P0) k yE N
Address of assign �� elBSON COUNTY AUDITOR
S N-elz. L .
Does applicant ovi tact? Has this deduction been requested If yes,state amount of deduction
other county r on property for
in Indiana? L current year? ❑Yes ❑No
A person is note 0—3 q I� ,the person's mortgage or contract indebtedness that is recorded in the county
recorder's office vv be county recorder's office)that is the basis for the deduction.
#b-21- II-Zoo-oo1 :46I-on }TYAUDITOR
Deduction approved in the amount of.
20 • 20 20 20 20' 20
Signature of County Auditoo County Date(month,day,yea
Argh
IP- C-Tic - 1 'Lf -2-- •
I/We certify under th- -enalty of perjury that r - ,r:• _ : oregoing information is frue and correct and that the applicant is a resident of Indiana and
owner/contract uyer of the afor mention d property on date application is filed.
ASignature,wne'
fina Date(month,day,year)
- 1/Z7r2v7.c7
Full ent dress of ap li (n er d street c d ZIP code)
1 et-3- Sys -
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 uo to two and a half years and a fine not to exceed Sin ono_