HomeMy WebLinkAboutMortgage_Corporation T;., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ounty Township Year
. =t. FOR DEDUCTION FROM ASSESSED VALUATION /�Jn,�
a i &SW PANASt. 2°
''.L/4 State Form 43709(R14/1-20)
�"�—%i� Prescribed by Department of Local Government Finance
�816
20
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 ownerorr contract buyer-see restrictions on reverse side) C
finer or c nt r t )5 C\(� 7(3n A
Ty kg g District Key number/legal description �� Record number Page number
V —r... aci - tom -0 7 ao , too a . ci39- °Ale X 0 41 i't
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 date of application legal or equitable owner?
$ (000 000 es No
If no,what is his/her exact share of interest? If owned with someone other than III
spouse, ndicate with whom
__
If name on record is different than that of applicant,indicate below: -- -ti•fin•• �in question:Annually Assessed
tip. . ;
' a y �perty ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ., \l'
A y
Address of ortgagee or cony`t seller(number and street,city,s Q{,an.IP code) G` '
•
Name of assignee or other owner or holder of mortgage ` P JO\���
Address of assignee(number and street,city,st G�vN�t
Does applicant own property in any If yes,wh � � uction been requested If yes,state amount of deduction
other county Drawer NO (((/// or
in Indiana? ❑Yes o ❑No
A person is not entitled to this deduction ur / or contract indebtedness that is recorded in the county
recorder's office(including any home equit Card N O• vG �� ice)that is the basis for the deduction.
Deduction approved in the amount of:
•
20 20 20 20 20 20 20
Signs re of County Auditor County Date(month,day,year)
1/ e certify under the penalty of perjury that t I/
ab 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' nature(owner's full name) , DaA(mont,day,year)
Full dents of apgJ�cant(number and street,city,state,and ZIP code) � l
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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.