HomeMy WebLinkAboutMortgage_Nally 46 •. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
, ..Y. FOR DEDUCTION FROM ASSESSED VALUATION
�
- / Form
" State 43709(R13/10-15) \�` ) $1 �`0n ZQ
`' ` / Prescribed by Department of Local Government Finan
INSTRUCTIONS: \
,
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.
App is nt(o�pwnn`err or ct own-se
s-9` fictions on reverse side)
Taxi "ctV l Key ri0fiber/legal description Record number Page n ber
n • 2"6-\22 e�7-Z.o3- fin) =T~'8 2�2 ' 2o2O °RC
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage i Contract indebtedness unpaidas of Is the appli nt the sole
assessment date,current year assessment date,current year date of appli tior�•� 0 co v0.2w►' - legal. e• itable owner?
/u^ ►:i Yes ❑ No
If no,what is his/her exact share of interest? If owned with some() e other than t)pouse,indicate with whom
If name on record is differentthan that of applicant,indicate below: a property in question:Annually Assessed
Real Property 0 AnnuailyAssessed
—et n JJJJf ��1��1 Mobile Home(IC 6-1.1-7)
Name of mortgagee contract seller (\ p/ t \ LL
Address of mortgagee or contract seller(number and sire . ,state,and ZIP cod i
ii
_
Name of assignee or other owner or holder of mortgage
I\.1 A'.A . 2020
Address of assignee(number and street,city,s r .c n.7,n•.,de)
R J
Does applicant own property in any yes 1 t \4lhatTaxing Distri 4 , -i_clI W�-deduction been requested If yes,state amount of deduction
intiIndiiaana? ❑Yes ❑No ''' G I B S O N C O U Th'e.,,yQ ryrr(1 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 f tyAudit County •C3O-^ Date(m t- oE0
I/We certify under the penalty of perjury that the above and foregoing information is true a�correct and that the applicant a resi ent of Indiana and
)(
I contract buyer of the aforementioned r •:- on date application is filed.
Sig hire owner' I name) Date(76,711.2.0 2 D
Fu t ress plir nu ber a stre it %idZlP cp�fel r-• 1� r b^ `
•
Person authorized by duly exec ed Power oil.mey or y IC 6-1.1-14-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.