HomeMy WebLinkAboutMortgage_Hoskins . ---*p�, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownshipYear
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FOR DEDUCTION FROM ASSESSED VALUATION
RECEIVED
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a i': �� State Form 43709(R14/1-20)
; Prescribed by Department of Local Governme n n e C I QE
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File Mark
INSTRUCTIONS: To be filed in person or by mail. O C T O 2 2020
Form filed with:
Filing Date: Form must be completed and dated in the cal ary a or which the deduction is sought. County Auditor
Must be filed or postmarked with the County Auditor r ounty Recorder of the county where the property is
located on or before January 5 of the calendar year in hich the property taxes are first due and payable. County Recorder
See reverse side for additional instructions and qualifications.
Applicant ow or qontract buyer s e est Mans on revers side)
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Taxing District Key n mbe lega description Record number Pa a nu er
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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 oplication� CO legal or�gyitable owner?
`C)O�((""]]11 ...--- /JL�Iyes ❑No
If no,what is his/her exact share of interest? If owned with so Bone other tan spouse,indicate with whom
If name on record is different than that of applicant,indicate below: I e palroperPr.ty in ques'. :AnnuallynuallyAssessed Assessed
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lobile Home(IC 6-1.1-7)
Name of mortgag -or co tr ct seller
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Address of mortga or contract seller(number and street,city,state,and ZIP code) 2
OCT 05 20
Name of assignee or other owner or holder of mortgage 4PPA—
Address of assignee(number and street,city,state,and ZIP code) IBSO (v p,VDfTOR
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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? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home 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 20
Signature of County t County \ \A^ Date(month,day, ar)
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I/We certify and he penalty of perjury that an foregoing information is t ue nd correct and that the applicant is a resi ent o Indiana and
owner/contract buyer of the aforementioned roperty on date application is filed.
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Full resident address of applicant(number and street,city,scat and ZIP code)
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Person authorized by duly executed Power of Attorney or by IC -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.