HomeMy WebLinkAboutMortgage_Cherry 0. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDN S County Township Year
�"7Z-1' FOR DEDUCTION FROM ASSESSED VALUATION
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`\ <d)� State Form 43709(R13/10-15) { 1 GI ON 2-Grit
° —me-- Prescribed by Department of Local Government Finance f y"
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INSTRUCTIONS: ✓/ File Mark
To be filed in person or by mail. U� Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is�Wjt.
Must be filed or postmarked with the County Auditor or County Recor s/of th ty where th eperty is County Auditor
located on or before January 5 of the immediately succeeding calendar? County Recorder
2) Mobile/Manufactured Homes not.assessed as Real Property:Must file with tl�e6AA ito f the county
where the property is located during the twelve(12)months before March 31 of each' is sought.
See reverse side for additional instructions and qualifications. TyA
Applican n or contract buyer-see re 'ctions on reverse side) i '/0 �v/)-O
(7t ! u ber/ I de iption Record number Page number
diz..be/171
- ®CEO. 0/6= O 6 2020 29 Yo .
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 da or pg{ycar i legal or equitable owner?
((��JJ(( ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned wit someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is e property in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 17 .../. 4i41/44
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Address of mortgagee or contract seller(numb and street,city,stt e,and ZIP code) /] /)
Name of assignee or other owner or holder of mortgage(/'//7— ed E��'L.S
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Address of assignee(number and street,city
— 9tY state,and ZIP code
( rl E R 2A/I Vv-�:J `' nn .What Taxing District? Has this deduction been requested If yes,state amount of deduction
I -A on property for '
1 O.nit ❑Yes CI No
`�' s a balance on.the person's mortgage or contract indebtedness that is recorded in the county is recorded in the county recorder's office)that is the basis for the deduction.
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v i9\--q5 ° COUNTY AUDITOR
20 20 20 20 20 20 • 20
Signature of ty Auditor County Date(month,day,year)
/We certify under a penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforeme 'oned perty on date application is filed.
/ Signature(own na ) ` Date(month,day,year)
Full reside ad s pp cant umber and reet,city, ate,an code) 971 yi Zvz
../7,7‘442
Pers 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 nenalties for neriunr can include imnrisonment un to two and a half years and a fine not to exceed S10.000_