HomeMy WebLinkAboutMortgage_Lee (4) R,*• STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS�.-�4 Count TownshipYear
i =%' = FOR DEDUCTION FROM ASSESSED VALUATION y
t, :ea > State Form 43709(R14/1-20) r . 014_Of—
-k,21.0e.
\ ,. Prescribed by Department of Local Government Finance
File Mar
k
INSTRUCTIONS: To be filed in person or by mail.
Fo m 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. ❑ ounty Recorder
See reverse side for additional instructions and qualifications. *�9 44 4),'
Applicant(own for contract buyer rest'do oh reverse side) -- S�
til ,e,0 J 1 � \3 L L . ,c2 (0--13-11 Adt u)_0 v 0.321 -0 0 6
Taxing District Keur ber/le I description /:::7) Record number Page number
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/ ntract in b dness unpaid ae of Is the applicant the sole
assessment date,current year assessment date,current year date of app.
t' C f� legal or able owner?
�./0' c Yes ❑No
If no,what is his/her exact share of interest? If owned with someo a other than ppouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is a property in question:Annually Assessed
eal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee contract selleramA x ^µ
C "`` r ' E /m i//�/ ) T , za
Address of mortgagee o contract seller(number and sire 7 °
Name of assignee or other owner or holder of mortgage '4-. /ILL / Sv/0 J 11 4 �UZ 3
Address of assignee(number and street,city,state,and B
Does applicant own property in any If yes,what cound2nn Indana? ❑Yes ❑No J// 84 iO/ ❑Yes ❑No
A person is not entitled to this deduction unless tF :ontract indebtedness that is recorded in the county
recorder's office(including any home equity line c v76�yv o ,that is the basis for the deduction.
Deduction approved in the amount of:
20 20 _-- y32/ __ 20 20
Signature of Cou ditor ...\L County Date(mo d y ar)
I/We certify 4.er the penalty of perju above and foregoing information is u and correct and that the applicant is a r sident ofl diana and
owner/contract buyer of the aforementioned property on date applicatio. lied.
Signatu e(owner's full narge))c
� Date(m9gfh, y,qr) � ^
7-7----` ,:de.,
Full resident address of applicant(num ( eet,city, g
P code)
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)
ri ......ls:,..,f........................1.._J_. .,..-...L.,..1,.I,..,......J.,h..li,....,......,.J-,F:.,e....{M nvnna,J Q//1 IIAA