HomeMy WebLinkAboutMortgage_Dewig (6) • STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.p FOR DEDUCTION FROM ASSESSED VALUATION
1`,r State Form 43709(R13!10-15) IN,Sp1\ f ,I� p , 20 2 0% ,,, # 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 grCounty Auditor
located on or before January 5 of the immediately succeeding calendar year. 0 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(owner or contract buyer-see restrictions on reverse side)
Taxin District Key numb legal description Record number Pa a number
. 26�k 8- 3 6-ki 04- p oo• 24 C-o09 20) t-1lkg3
Assessed value of real property as of Mortgage/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 CO legal ore !table owner?
.762 00O I Yes ❑ No
If no.what is hist her exact share of interest? If owned with someone otter than spouse,indicate with whom
if name on record is differentthan that of applicant,indicate below: I property in question:Annually Assessed
[ Real Property 0 Annually Assessed
• jr Mobile Home(IC 6-1.1-7)
Name of mortgagee or contractt seller
Address of mortgagee or contract seller(number and street city,state,and ZiP code) FILED
Name of assignee or other owner or holder of mortgage
FEB 17 2020
Address of assignee(number and street,city,state,and ZIP code)
Does
icant own property in any If yes,what county? What Taxing District? Has this deduoq - i tat cunt of deduction
countyother property fhP I:.:��I T ���Tt
in Indiana? ❑Yes 0 No current year? ■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 County Audito County \ Date(1Qonft ,yea 2o
Yl?\-\kel :..34) ,101\ .4-
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 1 contract buyer of the aforementioned property on date application is filed.
Xt Sr attire owner's full name - Date(mo day, ear)
/�•LI+� 2 ' --�2O2 ).
Full res t ress ofpph. «: (nu d stree te,and ZIP c de
11 s CA)ren S ,.3�rl- ki1 3°r
Person authorized by duly executed Powerrof Attorney or by id 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 oeriury can include imprisonment up to two and a half vears and a fine not to exceed S10.000_