HomeMy WebLinkAboutMortgage_Holzmeyer (6) ,Mn,Tea� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownshipYear
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'_)' %` y FOR DEDUCTION FROM ASSESSED VALUATION
z `l i="t ,> State Form 43709(R14/1-20) In O` Cam'
':`?"ie'%�' Prescribed by Department of Local Government Finance O
d
File Mark
INSTRUCTIONS: To be filed in person or by mail.
Form '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.
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Applicant(owner or contract buy e re t/ictions o`nfeve a side)
3-o�m�o( 3 lAe 1"fo�Zw1'�e�l .
Taxin Distr' Key number/legal description Record number Page number
• 26-Q`t-23-Soo-002 0cg -012 �� .
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 licaki �� legal or q ble owner?
II Yes ❑No
If no,what is his/her exact share of interest? If owned with so eone other titan spouse,indicate with whom
If name on record is different than that of applicant,indicate below: I, t,l�}1e'�property in question:Annually Assessed
Real Property ❑Annually Assessed
odi ✓ Mobile Home(IC 6-1.1-7)
Name of mortgagee or contratseller Aya 5k. FI ,
Address of mortgagee or con tact seller(number and street,city,state,and ZIP code) •
O C T 0 9 2020
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
GIBSON COl itriv -r-
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requesdd'G(.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
Signature of County Auditor County 1 Date(m pth da r ^ .
I/We certify under the pen of perjury that th and foregoing information is tru3d,„,f)
correct and that the applicant isa resid` t of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
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e) Datejmyrrlo I-resident ad ress applicant(number and stree, ity, tale and ZIP code) 1l Q��`JJ\\ �vl
*SI 22s- t� / 3�— L19-6 6 6
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 • Date(month,day,year)
• Address of authorized person (number and street,city,state,and ZIP code)