HomeMy WebLinkAboutMortgage_Price (10) .0Et* ,,, , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
`' '+�\ FOR DEDUCTION FROM ASSESSED VALUATION
il i1: L6 State Form 43709(R14/1-20) Q�`®' 1 �.S '70��
* -" l Prescribed by Department of Local Government Finance VC_
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File Mark
INSTRUCTIONS: To be filed in person or by maiL
Fo 'ed 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
number Page ber
d2$ 2G- i2 '-01- goZ1003. 6 - -Q2-8 V10 7 i . ,
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 a pliclx 00 _ p[� legal or q able owner?
("�Jl(�) f��J�� Yes ❑No
If no,what is his/her exact share of interest? If owned with so one othef than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: I e property in question:Annually Assessed
eal Property ['Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgag a or contract seller
n (xili.,;w_cylcw:s. 1-1-c . Fr if
Address of mortgagee or contract seller(number and stredf,city,state,and ZIP diod I il ... E
aj.,
Name of assignee or other owner or holder of mortgage
OCT 0 2 2020
Address of assignee(number and street,city,stat: 04 ZI Sty
Does applicant own property in any ocs��t: 2 untl What Taxing District? Has thi�Yrtltf�ttb7'1'7".:' ested If yes,state amount of deduction
other county G IaSI`girtOG U I R
in Indiana? ❑Yes ���o current year? Lf res LJ��
A person is not entitled tilt. is.[:.'a i. unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(includin•'t.„G ome 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
Signature of County Audi ( County 1 ` � Date year)
o
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I/We certify under t e y of perjury that the a and foregoing information is trt a nd correct and that the applicant i a r sident of Indiana and
pwPer/contract buyer oft aforementioned� t property on da application is filed.
Sir�tr re(� {� full name) I�1�7 �t L L l� DateCon'Vyey, ar) ,
VV (/� lV/ �h�^
FL res ent addresse of a lira t umbe ,a ,state,and ZIP code)
�
Person authorized by duly executed Power (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.