HomeMy WebLinkAboutMortgage_Market STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
,�.-' ' FOR DEDUCTION FROM ASSESSED VALUATION
��i _ tilA19
ro State Form 43709(R13/10.15) ��
'% ;.` d Prescribed by Department of Local Government Finance *
INSTRUCTIONS: • File Mark
To be filed in person or by mail F• led with:
Filing Dates: 1) Real Properly: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 /i 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 39 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
App bent(owner r gpgtraruyer-see restri bns pn reverse side)
Toxin istni \ Key number/regal descriptio �^ R d number Pa e n m r
��Gu -1 36—� --000 z44- Oo°i . .o�°� � .
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaidas of Is the applicant the sole
assessmentdate,current year assessment date,current year date of plieatirpng JJ legal o le owner?
�II�CK, (0 Yes ❑ No
If no,what is his/her-exact share of interest? if owned with so ne other thpti spouse,indicate with whom
If name on record is differentthan That of applicant,indicate below: property in question:Annually Assessed
Real Property 0 AnnuallyAssessed
- --- Mobile Home IC 6-1.1-7)
Name of mortgagee or contract-sell
sit,
....._ .
F11 _,,Ef _
Address of mortgagee or contract seller(number and street city,st /�0 1 n,
Name of assignee or other owner or holder of mortgage Drawer NO FEB'Q/� l_ 7 2020
Address of assignee(number and street, lam �'g city,state,and ZIP code)
Card NO. ,-
•
Does
Oh! COUNTY AUDITOR
Doesr applicant own property in any If yes.what county? i ..,.fl.mustily L./lbw-ra% Ha!s this �ction been requested `!ryes,state amount of deduction
oin Indiana? ❑Yes ❑No current year?r ❑Yes ❑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 20 20 20 • 20 20' 20
Signature of Countyi
rrmn z_
County \� Date(rtth0—I/We certi u enal of a at the above and fore oin information is and correct and that the a licant is reside t of Indiana and
fypenalty per] foregoing PP
owner!contract buyer of the aforementioned property on date application is filed.
X
Signature(owners fuilname) 7174 y Date mo
thtlie7
Fuli iQ�n re o piicar�(rlumbera stree state a dZlPco ) ^n �` ,_ ( c
Person authorized by du executed Power of Attorney or b})IC 6-1.1-12-0.7 `�Jl 1 b "�, Date o th ay, r)•
-2.-0
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.