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HomeMy WebLinkAboutMortgage_Shoultz (2) _,A---,,, ,,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year a FOR DEDUCTION FROM ASSESSED VALUATION ;iz bs Qttiat 2020 l • 1`� State Form 43709(R14/1-20) 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. y___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( wner or contract buyer-s e restrictions on re erse side) arr®a if A. a-Ka dig& d 2-- Taxing District Key number/legal description Record number Page number �ntt.bcat. 24.-iii -19- �lV 57 -00- ID CUD 9.0' o L1�3 , Ass 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 date application legal or q table owner? 31{0oo Yes ❑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: the roperty in question:Annually Assessed _ I Real Property ❑Annually Assessed / Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller Address of mortgagee or contract seller(r n 0 '- Name of assignee or other owner or holde �/(� VI- 1 •����` Drawer NO SEp Address of assignee(number and street,C �� _r7,c:,. Card NO. _� Does applicant own prope in y If y, duction been req 6} � tote amount of deduction other county for in Indiana? Yes No r? ❑❑ Y1� 1 5 A person is not entitled o 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 Siginr of ounty Auditor Coun_t„rji Date(month,day,year) � c f- and b,,5w� g•17rL02c� / e certify under the enalty of perjury t above and foregoing information is true and correct and that the applicant is a resident of Indiana owner/contract buy-r of the afore -ntio ed property on date application is filed. i Signature(owlnner's full n: e)Adi / ' Date(mont, ayr \ , ent ad+re s of applican (�ruber m - eet, .'as te,a7 1a5o e !it, CL i-� y°7L60 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) (((JJJ 1 The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.