HomeMy WebLinkAboutMortgage_Hofman (2) .M� *A*P�, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Countynshi
''%''= FOR DEDUCTION FROM ASSESSED VALUATION p Year
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a\- :t...i. State Form 43709(R14/1-20) Q, -( 9 J.v)
="016 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. 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.
Applicant(own�or co�tractibu�e`-see r f�tric 9 verse side)
Taxing District l� L//J( Key number/I: descvri^'Rtln Record number Page number
46�-a - 1 lio--`700-- I f- -6 ( 2 4 c o 4s-ti r"
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortg e/Contract indebtedness arid aid as of Is the ap lica the sole
assessment date,current year assessment date,current year date 46:000._____�' legal or qui ble owner?
t
es ❑No
If no,what is his/her exact share of interest? If owned with meone othran spouse,indicate with whom
If name on record is different than that of applicant,indicate below: s t property in question:Annually Assessed
Real Property El Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortga,-- • •1mtract seller n �.^n -^
AddreF .,f....rb,a ,..,*turf-ene.(r ...�.... -- -t -... _t-t^'-'ZIP code) Fit.?���111 ✓✓✓ C
Nan (- DrmiP, OCT �,. LO20
I
Add t
VEP '- ! GIBS
Doe Taxing District? TPgS'riis dedkkfi(a) equested If yes,state amount of deduction
°the I _ 1 on property for
in Ir 5 i. � l�-� current year? ❑Yes El No
A pe dance on the person's mortgage or contract indebtedness that is recorded in the county
recc ?rded in the county recorder's office)that is the basis for the deduction.
CC i j , COUNTY AUDITOR
Dec
I 2u 2U 20 I 20 20 20 20
Signature of County Auditor County Date(month da ear)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner,contract buyer of t e oremention property on date application is filed.
Signatu el' ll name) Date(month,day,year)
F I si d ress of a pli ant(number an st ity, t e,and ZIP ode) '
Person authorized by duly executed Power of Attorney dr by I 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
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