HomeMy WebLinkAboutMortgage_Beadle (2) ,MQn,\ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
°i' s FOR DEDUCTION FROM ASSESSED VALUATION County Township Year
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" : 9 State Form 43709(R14/1-20) 0a 8 ' ) 1'�.;eief 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. gr.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. •
A lican o er or contra bu r-see res 'ctio on re rse side) `�/1
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J wish-id Key umb /legal description Record number Page Humey..�.
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the a plicant the sole
assessment date,current year assessment date,current year date of application / legal or 'table owner?
�� Yes ❑No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate th
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If name on record is different than that of applicant,indicate below: Is t property in que nn al ses d
eal Property ❑Annual' ssl sed
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Name of mortgagee or contract seller ®�/ m e®2
rea
2020
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) G/� ��
Name of assignee or other owner or holder %age p �r /e (� �T(�
Address of assignee(number and street,c y,s.te, d ZIP code) S
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes ❑No current year? III Yes ❑No
A person is not entitled to this deduction unless the person has_a_ha!=n,.� --- • — btedness that is recorded in the county
recorder's office(including any home equity line of credit th 5 n _ ,/_,/ j asis for the deduction.
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Deduction approved in the amount of: o� '1� ('
Drawer NO
20 20 20 20 ' 20
Signature o ty Auditor Card N ( day,year)1 Date month,
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I I We certify under th v penalty of perjury that the above t ...._.......,..,, ailu ULU iuc[ana mat the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(ow -•:full name) Date(month,day,year)
Full resident address of-pplic2r7(number•n str t,oily,state,and ZIP e)
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Person authorized: duly exe9Gted Power of Attorney or by IC 6-1. -12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
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