HomeMy WebLinkAboutMortgage_Baker (5) eE*i* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS�,-- Fa, County Township Year
07 '_-`t .e
% FOR DEDUCTION FROM ASSESSED VALUATION
il-.I:i %IS
7., �,4. State Form 43709(R14/e 1-20)
'=� Prescribed by Department of Local Government Finance
Sal
File Mark
INSTRUCTIONS: To be filed in person or by mail.
rm filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. ounty Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where
Applicant(own° • cont r-see rest ons/onn re'venrse side) '' ��
District t /Jeri legal descriptionRecord number Pag tuberta
LU-eAL'O /� ��/-boo.oaf oo � aogo O?,
eased value of real property as o 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?
Jo/600 ❑Yes ❑No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indic-e with whom
If name on record is different than that of applicant,indicate below: Is the pro.A in st. :Ann+1r lly Assessed
Real Prope !f A n_: A sed
r I.n4orle(la 6-1.1-7)
Name of mortgagee or contract seller /j...--
Sep
2 2r�
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) )"r[�/1 U��
Name of assignee or other owner or holder of mort �' G/es N('
0 Ap
'/�� , •
OUST yA
Address of assignee(number and street,city,state,and I c e) vO/TOR
Does applicant own property in any If yes,what county? What Taxing District? Has thb
other county on prop 0 0 s 9
in Indiana? El Yes ❑No current
A person is not entitled to this deduction unless the person has a balance on the person's mortg
recorder's office(including any home equity line of credit that is recorded in the county recorder' Drawer NO
COUNTY AUDITOR
Deduction approved in the amount of:
Card NO.
20 20 20 20 2 •
Signature o Auditor %71z County Date(month,day,year)
/We certify under th penalty of perjury th a above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/co ct buyer of the aforemention prope n date plication is filed.
` Signature(o s full name) Date th, year)
•
Full % ess of nt(num !n- city, t,and ZIP c 1A.D w, .J. �/f iI ,
Person authorized by duly executed Power o ttorney or by IC 6-1.1-12-0. ri/s�C/ tiL /•/(/�/CJ Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
The nenaltie.c for nerinry ran include imnrisonment sin to two and a half years and a fine not to exceed. 10.000.