HomeMy WebLinkAboutMortgage_Phelps (4) r'' • ..l- '
6!T4Tp STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
°`,i FOR DEDUCTION FROM ASSESSED VALUATION County Township� +p Year
,; "0 20
Nf .- S
', .l) State Form 43709(R14/1-20) ,�,5s)r 0 ZQ
� z%j Prescribed by Department of Local Government Finance J
role
il Mar
INSTRUCTIONS: To be filed in person or by mail.
Form I
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. AUG 2 .fla
ounty Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is
located on or before January 5 of the calendar year in which the property taxes are first due and payable. ty Recorder
See reverse side for additional instructions and qualifications. .
Applicant(owner or contract buyer-see restrictions on reverse side) GI$SU COUN?
D�iv/e` E.. Ptiff - I c1�a-a ola ccd IC.-dads YAUDIToR
Taxing District Key nu ber/legal description Record number Page number
D 2- (o �' / ,y;c.o f'ciT1�s/T .��A, -4)U ;g t493
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 of application / legal or equitable owner?
y 2- 7 2. d G L4r El No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
- [}Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or vontract selle
fi7& "1 X f iii�i"-c /- c
Address of mortgagee or contract seller(number and street,city, co state,and ZIP de)
,y8 L'Lv e'er£,� ,2.* ,iec - //c4If✓,tOL l' y yDzV3
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 county _ _ on property for
in Indiana? ❑Yes [a110 current year? ['Yes [�-td"o
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 amount of:
20 20 20 20 20 20 20
Signature o y Auditor • County Date(month,day,year)
I/We certify under he penalty of 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 aforementioned property on date application is filed.
S' ure(ow ll n Date(month,day,year)
e' ' 14 esi1 — r-/�2cz c
resident ad ress of applicant(number and street city,state,and Zlf�de
Z Z o j' 7�Y GOst �v C f� /NCf'%!,' 7 4171.7o
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)