HomeMy WebLinkAboutMortgage_Pritchett II j rP STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
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FOR DEDUCTION FROM ASSESSED VALUATION
1' , 11 State Form 43709(R13/10-15) GIBSON
e• '516.
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 ❑ 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 reSdftions on reverse side)
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Taxing District Key number/legal description Record number Page number
9n\ \ye_ a� -1a, - \� - ► Q? con. tam- 8- 202 0 2
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 ap lication legal or equitab owner?
4 gI ,Qtq ,°eL es ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the. +perty in question:Annually Assessed
-t ;--al.Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7) _
Name of mortgagee or contract seller .----,
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) ✓ ,
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Name of assignee or oth owner or holder of mortgage
I ,, p mortgage .��
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Address of assignee(number and street,city,state,and ZIP code) �/L' th
Does applicant own property in any P j -F er 11_ eduction been requested If yes, to amount of deduction
other county / I` ( y for "/(/
in Indiana? ❑Yes " No 11 ar? es ❑No /�.
A person is not entitled to this deck 1 I2_j LJ re or contract indebtedness%is recorded in the county
recorder's office(including any hor 1 office)that is the basis for the deduction.
Deduction approved in the amount of: V 553
20 20 20 20 20 20 20
Sig lure of County Auditor County Date(month,day,year)
(—D.. I \I-o n . —\Q — DOD.
I/We certify under the penalty of perjury that the aboveng information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner' me) Date(month,day,year)
Full resident address of applicant(number and street,city,state,and ZIP code) •
_/ J� /
Person authorized by duly executed Po r of Attorney or by IC 6-1.1-1 7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
The nenaltiec for neriury ran inrinrle imnriconment lin to hmo and a half vearc and a fine not to eviceerd!11n nnn