HomeMy WebLinkAboutMortgage_Mcintyre (6) ^"• STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS T"County Township a ' zt FOR DEDUCTION FROM ASSESSED VALUATION — Year
-•?'r" '' State Form 43709(R14/1-20)
S , Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be bled in person or by mail.
Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. ❑ County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is
located on or before January 5 of the calendar year in which the property taxes are first due and payable. 0 County Recorder
See reverse side for additional Instructions and qualifications,
Applicant(owner,or contact buyer-see restdc io s on reverse side)
(�ca n_c)- i n I'�c.In4 i-c
Taxing District Key numb2 al rintionZ Record number Page number
It 07 ^ 09 b^ _o24 Zo20 Iki12 .
Assessed value of real property es of Mortgage/Contract indebtedness unpaid as of ,futortgaggl.Contract Indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment data,current year 'date of a fi tion co legal or equlta owner?
� es ❑No
If no,what Is his I her exact share of Interest? If owned with someonerr thb en spouse,Indicate with whom
Interne on record is different than that of applicant,Indicate below: p d� Nit
Is the,pperty in question:Annually Assessed
C\J(���v 11\e. Te e,het5 Fed C...1 c ) EealProperty ❑Annually Assessed
Mobile Home(IC 0-1,1-7)
Name of,rnartgagee or contract seller ���—
________It, . . . .—
Address of mortgagee or contract seller(number and street,city,stale,and ZIP code)
Name of assignee or other owner or holder of mortgage 4/O 9, '.. 410:'
Address of assignee(number and street,city,state,and ZIP Code) Oh, 2 Z
t904-
Does applicant own property in an If yes,what county? What Taxing District? Has this deduction bean reques t Late amount of deduction
other county on property for ,—,,,1' ❑No 4/ - '40
in Indiana? ❑Yes 0 current year? 4d res
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract Indebtedness that4 corded 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 de atj'
COUNTY AUDITOR iQ
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
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..f contractbuyer of the aforementioned property on dale application is filed.
Signature(owner's' Il mine) Date month day, ear)
Fulll.rresidrnrnentaddress:of.ep`pficart ,,(mbar
end
ssf 1-11-ty ag st slate;�end ZIP code . ,t a& '/y�J�/�
-(� I 1
Perscn a horized by duty execut ower:of A torney,or by iC 6-1.1-12-0.7 Date( onth;da); ea
Address of authorized pe (number and street,city,state,andZ code)
The penalties for perjury can include Imprisonment up to two and a half years and a line not to exceed$10,000.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDN
Name of applicant Name of mortgagee or contract seller it 1
Date f ed(month,day,year) ]An '2eAmount
` ss 9z a Dis
• :Key du er!legal s wn t\
sig lure of.County.Auditor!County Re rder Cr...ty M�Q�Date(mo \�
►� . Cig-
off- _..
GO
Os4'