HomeMy WebLinkAboutMortgage_Cantrell „;R STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cunt Township i Y Year
cif .' . FOR DEDUCTION FROM ASSESSED VALUATION (� NI,.
t —
s' Stale Form 43705(R14 I 1-20) RECE J."'1T.S•Wl
O� LW',” I• Prescribed by Department of Local Gove_rnina t FinTe
\INSTRUCTIONS: To be filed in person or by mail. e� C C eile Mark AUGA U G 1 1 2019 Form filed wi
Filing Date: Form must be completed and dated in the calendar year for w is the deduction is sought. County Auditor
Must be filed or postmarked with the County Auditor or County ecorder of the county where the property is
located on or before January 5 of the calendar year in which th property taxes are first due and payable. ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
i�_Cde r`t c. t- Q r-e((
Taxing District Key number/legal description R rrd number P n
Q(D-Ig-I3 - q01 -000. 3 �- oat 0 �
Assessed value of real property as of Mortgage/Contract indebtedness unpaid es of Mortga ontract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of a Ii 6 legal or equitable owner?
ci . pit fifes ❑No
If no,what is his/her exact share of Interest? If owned with someone ,.-_• se,'n. ;ith whom
If name on record is different than that of applicant,indicate below. A UG 1 roperty In question:Annually Assessed
03roperty ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ,
eT U�Y_3VI_U_ _�a-S Fcu GJBSoN
Address of mortgagee or contract seller(num er and street,city,state,and ZIP code) C N Ty A..DITOR
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property In any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other on property for ❑Yes ❑Non Indiana? ❑yes �Na current year? .
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded 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 deduction.
COUNTY AUDITOR
Deduction approved in the• unt of:
20 20' 2 20 0 20 - 20 i.
1_,. .tantr.„..,Signature of County Audit. / \ County �� Date(mo ,diy,„yearh n ^ `I/We certi under th-�penalt of er'ury that the information is tru a d correct and that the a licant resideeit(off IInddiann/a1`faannd
fi y P 1foregoing applicant
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name) Date(month,day,year) •
c �,� A - 7-T I -Z0z0
Full resident address of applicant(number end street,city,state,and ZIP code)
30_L Al, 1454- s-1- -Fofi r\ci --- L- o�L
Person authorized by duly executed Power ofAttome/or by IC 6-1.1-1 0.7 Date(month,day,year) •
Address of authorized person (number and street,city,state,and ZIP code)
The,nnnaltiec for nerlury can include imprisonment up to two and a half veers and a fine not to exceed S10.000.