HomeMy WebLinkAboutMortgage_Bullock .M,`'"*. , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�"• *1 FOR DEDUCTION FROM ASSESSED VALUATION
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t .,:� ' State Form 43709(R14!1-20) (�„
• 0 Prescribed byDepartment of Local Government Finance
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File Mark
INSTRUCTIONS: To be filed in person or by mail. J
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 , A
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 or contract buyer- restrictio n rev r e side)
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Taxing Dist' Key nu er/I descri ' n Record number P e number
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mo gade/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year d o1app(i ^ legal,or a it able owner?
[/ /'LJ Yes ❑No
If no,what is his/her exact share of interest? If owned wi someone other than 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
// Mobileit ; , Home(IC 6-1.1-7)
Name of mortgagee or contract seller M •� �x
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Address of mortgagee or contract seller(n��-^f•--'-^"�•--'-'� �'
Name ofnssignee or other owner or hold( SEr 1 2.02.0
Drawer NO � ®),c� 111 I._i
Address of assignee(number and street
•
Does applicant own property in any If y Card NO. `" :iiuction been r�'gti I yes,stateamount of deduction
ino Indiana?er Yes No ir?r ❑Yes ❑'No
in Indiana? ❑ ❑
A person is not entitled to this deduct ?or contract indebtedness that is recorded in the county
recorder's office(including any home equity fine 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 of Calk •'tor c_\)I County Date(month ay,year)
L` * C%(3 SO1 '` Li. 1.J-w•
I/We certify under the penalty of perjury t artne above and foregoing information is t e and correct and that the applicant Is a eside;tt of Indiana and
owner/contract buyer of the aforemen'on=d grope,(on date application is filed.
Signat •(o,ners full na-: Datmo �,tla
l 92:20 4.0
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*len dress•/pplicant(numb= a d stree ci ,state,and ZI d)I W� � ,► . y\ - ka-6(9.0
Person authorized by duly executed Power of A-•mey or by IC 6-1.. -12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
•- '-s for•erjury can include imprisonment up to two and a half years and a tine not to exceed$10 00. •