HomeMy WebLinkAboutMortgage_Titzer (3) �.„ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
c, ter:.. FOR DEDUCTION FROM ASSESSED VALUATION
F ri''= State Form 43709
,-:;i.*' Prescribed by Department of Local Government Finance
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(o ner or contesee restrictions on reverse side)
7
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Taxing Vjstrict K be al des; on R m r Pa umber
s� , � —� 105—o of .�2l - 024
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortga e/Contract indebtedness unpaid as of Is the ap licant the sole'
assessment date,current year assessment date,current year date pt � - J legal or ui le owner?
l�/> J _ es ❑ No
If no,what is his/her exact share of interest?. If owned with so one othe than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: property in question:Annually Assessed
Real Property 0 Annually Assessed
9�° ��9� Mobile Home(IC 6-1.1-7)
Name oft, I' \ee orcrtract seller .. IL1iED
Name of ass, i u 4 (..._'1 AG ° Z G
FEB 10 2020
Address of a:
Does applica / / N District? Has this/tl ested Ayes,state amount of deduction
other county ®13�t ®O<dTY AVPITOFZ
in Indiana? current year? es Li No _
A person is, I--a on the person's mortgage or contract indebtedness that is recorded in the county
recorder's o / 9 6 mac), in the county recorder's office)that is the basis for the deduction.
JNTY AUDITOR
Deduction al 5
20_ �` `� — U S / D • 20 20' 20
Signature of County Auditor / �1 n /rcr�/►1.) - County • Date(month,day,year)
5,(Al
certify under - •enalty of perjury thatv the ab Y e going information is true and correct and that the applicant is a resident of Indiana and
owner contract b er• the aforementioned property on date application is filed. -
gna (owner's full name)1c Date Datelth,da ar)
6.441-4 -I ,66.44
•
Full rg�ident address Qf ap ,cant(number and et, ily te,and ZIP c e)
lI.tiL4G `� t� r_ I
Person authorized by duly executed Power of Attorney o iC 6-1.1-12-0.7 Datftt Tel ear)
of authorized 2�2'0
Address 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.