HomeMy WebLinkAboutMortgage_Freeman (2) cif n�0, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
T.__. _ t, FOR DEDUCTION FROM ASSESSED VALUATION
I! •nt i=
• f State Form 43709(R13/10-15)
''-1eie �:=- " Prescribed by Department of Local Government Finance
INSTRUCTIONS:
File Mark
To be filed in person or by mail. `� 1‘„t For led with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendor which the deduction is sought.
Must be filed or postmarked with the County Auditor or Coorder 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(owner or contract buyer-see restrictions on reverse side)
Ta(A210 M . Ficernian
Taxing District Kex number/legal description Re9grd number Page number
la-I -7- 01 - g0II -coo, Dig - oaa (' la3a,
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
K8 a-7 , . Co yes ElNo
If no,what is his/her exact share of interest? If owned with some ne other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
'-Real Property El Annually Assessed
Mobile Home(IC 6-1.1-7)
Na of mortgagee or contract seller
Address of mo tgagee or contract seller(number and street,city,state.suld ZI 'de
Name of assignee or other owner or holder of mortgage FILED
Address of assignee(number and street,city,state,and ZIP code) MAR 19 2020
Does applicant own property in any If yes,what county? What:axing District? Has this deductionL5E
een r uested If es,state amount of deduction
other county � roperty f r
in Indiana? El Yes LK No Ye No
A person is not entitled to this deduction unless the person has a ba'nce on thethwai,wpArn. >:' 41I' ITnSlt Hess that is recorded in the county
recorder's office(including any home equity line of credit that is recor.ed in the recor.er's office) at is the asis for the deduction.
CoUNTYAUDI
Deduction approved in the amount of:
20 a / 20 _ 20 20 20 20 20
Signature of County�•or Cour�y i� Dateon h,day��eaT�
✓ •
l L le
I/We certify under the penalty of perjury tha a above and foregoing informa is true and correct and that the applicant i a resent of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name) Date(mo th,day r)
*1e-�` '— .'437-0
Fu resident addr s of applicant(number and street,city,state,and ZIP code)
501 N. 1Il�.in ,Sfi / O(�11°�1so ( (-P, I- 710 (e S
Person authorized by duly executed Power of Attor ey 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 oeriury can include imprisonment up to two and a half years and a fine not to exceed.R1 n nnn