HomeMy WebLinkAboutMortgage_Rahman .MeF4�0, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
°`•'%~_ FOR DEDUCTION FROM ASSESSED VALUATION
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"\ua. ;,L> State Form 43709(R14/1-20)
.y �",',.-,3- ----, 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. KCounty 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. I gla-3 5 33« '
Applicant ry er.l .ntract bu er-sl:e estri tions on reverse side)
I r 2i,' sM
Taxing District I ' Key number/legal description Record number Pa a number
26-I2-16-2-oo--0n2 _ lS4- 02�- Zd2O ,3R)'1—
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 pljC�t•on legal or q itable owner?
((00 �500// ��✓ Yes III
If no,what is his/her exact share of interest? If owned with so one other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is•• property in question:Annually Assessed
►A Real Property ❑Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller FILE
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Address of mortgagee or contract seller(number and street,city,state,and ZIP code) (�
Name of assignee or other owner or holder of mortgage OT 07 20211
40.4._.. .
Address of assignee(number and street,city,state,and ZIP code)
GI[3S9P CPI INTY AUDITOR
Does applicant own property in any If yes,what county? What Taxing District? as 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 Colt.
r ' \ County Date( th, y,year)
. k I/We certify un. e penalty of perjury that the above and foregoing information is true and correct and that the applicant is a re ident of Indiana and
owner/col act buyer of the aforementioned property on date application is filed.
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Cr's fgi
Date( n a year)
Full rj�'l tdrespr t(number and street,city,Stall,and Zll Io ec() 30 r _) r 9
c.
Person authorized by duly executed Power of Attorney or by IC 6-1 11-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)