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HomeMy WebLinkAboutMortgage_Judkins 4.,,Em,`4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownshipYear ifir-i'' FOR DEDUCTION FROM ASSESSED VALUATION ' ', t.., 7 State Form 43709(R14/1-20) \- 00 D.2 .� �,/v.i-a :- Prescribed by Department of Local Government Finance ���JJJ File Mark INSTRUCTIONS: To be filed in person or by mail. F rm '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 the property taxes are first due and payable. County Recorder See reverse side for additional instructions and qualifications. Applicant( or co+n�buy -�r�sM�s on reverse side) Taxing District Key number/legal description Record number r Page ae number 2c,-. (2--o1-yd3-ooD . ` o -02 ��2 , Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/C ract indebtedness unpaid as of Is the applicant the sole assessment date,current year assessment date,current year date of appl' ton r legal o !table owner? r �©O^ , Yes ❑No If no,what is his/her exact share of interest? If owned with someo other han sp1use,indicate with whom If name o 1eir is differe n hat f applicant,indicate below: property in question:Annually Assessed / Real Property ❑Annually Assessed \ Mobile Home(IC 6-1.1-7) Name of mortgagee or contract se r N Els) Address of molt! .. • `- - _,...,... .•a.,-cr�#<_on,i-71P_.rnde) I . Name of assigne OCT V 82°20 Address of assig Drawer NO 2010. 1 ... -% p.'. n R Does applicant c 2 2 strict? Has this IR DO • csYte��Tfi yes state amount of deduction other county 7 J J on prdpiel in Indiana? Card N O• current year? ❑Yes ❑No A person is not n the person's mortgage or contract indebtedness that is recorded in the county recorder's office 1,,,..,—,,,,....,.._...__,_._, ...._ _ 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 Coun u i r (.\--- - ` County Date( h,d}gar I/We certifyun r tPe penalty of 'u that the a e and foregoing information is true and correct and that the applicant is a esiidd�\/ert of Indiana and P Y 9 9 PP own /contract uyer of the aforementioned property on date application is filed. Sign a(owner's f nam Date nt , 1 �r}� ^/� „ t` / F II resi nt addres I' ant(number and street,city,state,and ZIP code) Person authorized by duly executed Power 6f Attorney t%r 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 nenalties fnr neri,,ry ran include imnrisnnment un tn twn and a half years and a fine not tn exceed.sin nnn