HomeMy WebLinkAboutMortgage_Woods .fir-F-4 , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
- , County Township Year
° � � FOR DEDUCTION FROM ASSESSED VALUATION
�a CI50P C \ c�2o
I�� �:` �1 State Form 43709(R14/1-20)
'';.ig--9 Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail.
Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. County 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. ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner occon ra buyer-See restrictions on reverse side)
-iiiMctu Og mis&J000,5
Taxi trict Key number/legal description Record number Page number
ax lcriit�' ,i�25'hm •cm. 956- 202019S I
Assessed value real propert of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant sole
assessment date,current year assessment date,current year date of application legal or equit e owner?
(162QL�,D es ❑No
If no,what is his/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: t property in question:Annually Assessed
I Pre l "a.■Annually Assessed •
, Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract sellern7402.210—
ii-Cee.; Af- .
Address of mortgagee r contract seller(number an -- ^' ‘15:)
aQ
_1,1pc
Name of assignee or other owner or holder of mortc • CO , ()CI'
Drawer NO....623 ( tk�� c),
Address of assignee(number and street,city,state, `�
Does applicant own propeit in ny If yes,what, T h been reques e��it`yyees,state amount of deduction
other county ' Card n O. . .. 13 ( ,
in Indiana? ❑Yes g No •• ❑YeS 0
A person is not entitled to this deduction unle: ontract indebtedness that is recorded in the county
recorder's office(including any home equity line or urcwr ...-.._ __. - that is the basis for the deduction.
COUNTY AUDITOR .
Deduction approved in the amount of:
20 20 20 20 20 20 20
Sign Lire of °Linty Audi or Count Date(month,day,year)
( 5I b s i4L-70 2/O
II e certify under e p nalty of perjury'tFjfe above and foregoing information is true and correct and that the applicant is a resident of Indiana and
ner/contract buyer of the aforementio property on date application is filed.
SigngtDfe(.eel full name Date(month,day,year)
+' 9• 174-2r�2v
Full resident a dill ss of appl t(number an street, ,state,and ZIP code)
/a 7//-O 850 a), odje Leqr 4,7 h 33
Person authorized by duly executed Power of Attomey or by 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. 4