HomeMy WebLinkAboutMortgage_Elliott eT°, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.1,_4-:: a FOR DEDUCTION FROM ASSESSED VALUATION
t.:,;l State Form 43709(R14/1-20) 3 30"
s<"�a�s'%•� Prescribed by Department of Local Government Finance
Del (+loon
County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is
located pn or before January 5 of the calendar year in which the property taxes are first due and payable. County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer- ee'Aso i.ns on rever r e) .
\Ory C7 (0 lib' �v'6 1} 1
Taxing District Key numb. / egal description Record number Pa a number
IV— )L c 1 -0�1 A50 Den- 2c00o g •3col
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgag /Contract indebtedness urtpaid as of Is the appli nt the sole '
assessment date,current year assessment date,current year date pli n e (�h . legal'ore ble owner?
cS)V • es El No
If no,what is his/her exact share of interest? If owned with s eone other thap spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is property in question:Annually Assessed
. eal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
fill L „. .,,,--,
Name of mortgagee or o tact seller
_ T
.
Address of mortgagee or contac eller(number and street,city,state,and ZIP code)
S EP 0 3 20211 •
Name of assignee or other owner or holder of mortgage
-Address of assignee(r — — _, _--
-
- ON COUNTY AUDITOR
Does applicant own pn Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Ye
Drawer NO )..b0 current year? ❑Yes No
A person is not entitir eon's mortgage or contract indebtedness that is recorded in the county
recorder's office(incl ty recorder's office)that is the basis for the deduction.
Card NO. •QQ,• ITOR
Deduction approved in • ..,.. •
20 20 20 20
1
Signature"ty Audi• County Date(moth,day,year)
1/We c under the pena v . perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
o /contract buyer of the aforementioned property on date application is filed.
gnature(owner's full name) Date(month,day,yea
Fuil dent address p icant(numb r n street,city,state,and IP ode C'DI i
Person authorized by dul cuted Flower 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 oenalties for oeriury can include imprisonment uo to two and a half years and a fine not to exceed$10,000. _