HomeMy WebLinkAboutMortgage_Harmon (2) 0 \ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
17 � �s County Township Year
FOR-DEDUCTION FROM ASSESSED VALUATION
'` - State Form 43709(R13/10-15) GIBBON 0 A, X
Prescribed by Department
❑ County Auditor
located on:orbefore January'S of the immedietelysucdeediing calendar yea' E.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 in tructions and qualifications.
Appr wner contract buyer- ee r s lions on reverse
t_c&CA VI
Taxing D s t 22 - Key number/legal description Re b(1‘-1 Z--0 — � — d o2 �-�9— C7� numb
, Page number
0
Assessed va ue of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/C tract indebtedness unpaid a of Is the applicant the sole
assessment date,current year assessment date;current year ' " date of appl' tionQ� ' ' ' ,p legal or '`'table owner?
tl O- Yes ❑ No
If no,what is his/her exact share of interest? ` • If owned with someo a other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: I t -property in question:Annually Assessed
.. I. Real Property ❑ Annually Assessed ,:
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ETF, 1 a 1,
rr
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) `
Na AUG 17 2020 ' , - .. .
Ac
Drawer I\TO. .. .a/mil
I•rit Y AIMITOR
CII3. O.N.COJ. `
Dc hat Taxing District? Has'this deduction been requested , If yes,state amount of deduction
otl on property for '
in Card NO. ��\J current year? Yes ❑No
A F a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorded hi.the county recorder's office)that"is the basis for the deduction. `
. COUNTY AUDITOR
Deduction approved in the amount of:
•
20 2 20 20 20 ' 20 ' 20
Signature'of County Auditor l - 'County \-SQ1
Date( emir)
I/We certify under the penalty of perjury that the above an 'nformation is tr eid correct and that the applicant is a esident f Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signatu �wn iit fullname) Date(modal ea)_)„.2.„ /2„....
y
Full residentaddress of licant(number and tre , 'ty,state,angyIR code)
f06 0o_ )- /-) V 1 .(-) - rl " L-41 G
Person 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 0 to two and a half years and a fine not to exceed S10.000_