HomeMy WebLinkAboutMortgage_Weber (9) „,.E.T.rF4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownship
1��_�,,y Year
FOR-DEDUCTION FROM ASSESSED VALUATION
i 1, 202c
• State Form 43709(R13/10-15) GIBBON I
--ir Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
To be filed in person or by mail. F m ilea 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 yean i 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 rest'ctions on reverse side)
Taxi Di^ct Ke umber/legal description Record number Page number
11 v) r • 12-1 t, - 1 - - 20 6--O? 20 2-o �.I oki .
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract inddbtedness Unpaid as of Is the pplicant the sole
assessment date,current year assessment date,current year ' • date of ap I'cation legal o itable owner?
000 — Yes El No
If no,what is his!her exact share of.interest? If owned with som one o her the('spouse.indicate with whom
If name on record is different than that of applicant,indicate below: s th property in question:Annually Assessed
.. al Real Property ❑ Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name o\ eiOi
gQr contractsel tl�``-� (7 •
V
Address of mortgagee or contract seller(number an St eta ,state,and ZIP code)
4o — //off JUL 202020 . .
•
•
Drawer NO ,I ,, ,/ P.< . . ,
iat Taxing District? Has th'5 uc •- ,Act9orpCS 1 yes,state amount of deduction
GIn'nt bd ❑Yes ❑No• - current year?
Card N O: I balance on the person's mortgage or contract indebtedness that,is_recorded in the county
ecorded in the county recorder's office)that is the basis for the deduction:
COUNTYAUDITOR .. ..
-Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature'of County Auditor County Date_rivo h,day,y” .ij
20 2.6110 -
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a reside t of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(ow r till name) Azi/‹.. /1 Date(mont day,aivale?/Q
F r den address of r t(niEber and stye li ,state,and ZIPecoode) ±j
Person authorized by duly executed Power of AttJrney 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 up to two and a half years and a fine not to exceed$10.000.