HomeMy WebLinkAboutMortgage_Marrs 0`-`"0 , STATEMENT OF MORTGAGE OR CONTRACT INDE SS ‘----I of ay Township Year
�( AFOR DEDUCTION FROM ASSESSED VALUATION --
"`ii f State Form 43709(R13/10-15) 2=--4/G•8-8'a N
•
v•• ' Prescribed by Department of Local Government Finance
INSTRUCTIONS: J U N 3 0 2020 File Mark
To be filed in person or by mail. Form file with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the d duction is sou. t.
Must be filed or postmarked with the County Auditor or County Recorder of the c W.-!- property is County Auditor
located on or before January 5 of the immediately succeeding calendar year. Wiwi,.
2) Mobile/Manufactured Homes not assessed as Real Property:Must filQ eklatc0 14.13il!t5n01[ibielW Ry
❑ County Recorder
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.
Appli o r contract bu er-see re 'o s n reverser side)
/ l cL 1 Ctirl
J-- �Taxing District (^ e number/ ggaawl dne`n i;7 ... cord number Pa a number
Q-4, t��-mo//- G -c 3. g79-0017 0 2d 29 4
Assesse value of real property as of Mortgage/ ontract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year asses en(t]date c` a eeaar date of application - legal or equitable owner?
4. i —1 JI 70 ❑ Yes ❑ No
If no,what is his/he xact are terest? If owned with someone other than spouse,indicate with whom
w ,
If name o riet
c d a ent th0Applican indicate below: Is the property in question:Annually Assessed
w ❑ Real Property ❑ Annually Assessed
�\�\\� at , C0 Mobile Home(IC 6-1.1-7)
Name of mortgagee or a retract seller ► I JQ1 (�,
x'c't ar2A,5101 Cie`jCiAL
Address of mortgagee or co 1,j:.:�s {&*number and street,city,state,and ZIP code — - --
'Name of assignee or othfibewne or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) Drawer N O.au:a°
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction ^
a —I
other county on property for T —I
in Indiana? ❑Yes El No current year? C N Card O•
•
A person is not entitled to this deduction unless(he person has a balance on the person's mortgage or cot
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is me oasis tor me deduction. -
COUNTY AUDITOR _ °
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signatur of ounty Auditor County Date(month,day,year)
I/We certify under the penalty of perjury that tr a .j . •i foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned , i•e • date application is filed.
ig�n ,iowner's full name)Z�� Date(month,day,year)
y� —
ea %nt address of applicant(number and street,city,state,and ZIP code)
PU•557a 1_1, Si /S 0 ei,es L 7 erre 14-a,u.� -b-) �
t_ �q '5
rson authorized by duly executed Power of Attorney 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 perjury can include imprisonment uo to two anti a h.rf -•-_,- '--- '