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HomeMy WebLinkAboutMortgage_Sisk (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year *; FOR DEDUCTION FROM ASSESSED VALUATION a' .., .-_ti. State Form 43709(R14/1-20) ' 1 ©Z I 70'20 rein ;,-;" Prescribed by Department of Local Government Finance c5� 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 soug): County Auditor Must be filed •or postmarked with the County Auditor or County Recorder of the county l e t .Ue petty is located on or before January 5 of the calendar year in which the property taxes are fir h.ue d tt•yabl E County Recorder , See reverse side f• -dditional instructions and qualifications. 4P.- Applicant(owner ,< ontra• buyer- frictions on re erse side)40K ®C r Taxing i. t ey•u • r/Ie Idescri ! Recor u byx, Page nurdry irf .i 404'll-- Z- /, r0—00 '> ,5/ e ,•N • /el Assess d va ue•/eal prop y as of Mortgage/Contract indebtedness unpaid as of7Mortgage/Contr C i npaid-as of Is the applicant the sole asse ment da- current y assessment date,current year date of application `,, legal or equitable owner? 0, ,�•�j!O Yes El If o,what is his/her exact share of interest? If owned with someone other than spouse,indicate w-ah whom If name on record is different than that of applicant,indicate below: Is th roperty in question:Annually Assessed Real Property ❑Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller (i/ QlCr4 Address of mortgagee or contract s tuber and street,city,s ate,and ZIP code) Name of assignee or other owner• ,jof mort . / iiir -S-3 / ,,(qc Address of assignee(number a ity,state,and ZIP code) Does applicant own property in any If yes,what county? What Taxing District? Has this--'.•+•,sion_been requested !If yes,state amount of deduction other county on prop in Indiana? III Yes ❑No current d D �D ` S v /A person is not entitled to this deduction unless the person has a balance on the person's morts pL recorder's office(including any home equity line of credit that is recorded in the county recorder; COUNTY AUDITOR Drawer NO Deduction approved in the amount of: 20 20 20 20 i Card NO. Signature n Auditor County • I/We certify under the penalty of perjury at the above and foregoing information is true and correct and that the applicant is a resident of Indiana and owner/contract buyer of the aforementioned property on date application is filed. Sign re(owner's full name) Date(month,day,year) 4 - Fu esident address of appl ant(number d street city, •e,and ZIP V7-‘;‘5.--- Person authorized by du y executed Power of Attorney or by IC 6-1.1-12-0. Date(month,day,year) Address of authorized person (number and street,city,state,and ZIP code) The nenalties for neriury can include imorisonment un to two and a half years and a fine not to exceed, 10.000.