HomeMy WebLinkAboutMortgage_Pflug 0Em,=., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�•3 FOR DEDUCTION FROM ASSESSED VALUATION
�'„.,, ;_L + State Form 43709(R14/1-20) q,sQ,r\ 028 ^ 2,02.- ,
,mere>-'. Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail. F rm 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 si.-f r additional instructions and qualifications.
Applicant(oI n act buyer see re ctio//s on•reve e side)
Toxin. ri Key n ber/legal descriptio Record number Pag- - -
A -/o? -0 7- 303- OCR?./..`1-6a9 210� t 2
Assesse 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 applicay legal or qui ble owner?
(es ❑No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom ✓✓/���
If name on record is different than that of applicant,indicate below: !' Ist property in question:Annually Assessed Real Property Ij. nually Assessed
ome(IC 6-1.1-7)
Name of mortgagee or contract seller 2_7__ ___. A 2
4 „'
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) On 4.
Name of assignee or o h-A �i er or h r of mo C ®e7
. .0 a / oXu 7 02-/G .�/g& peso�� . ���u
Address of assigne- numb r nd street,city,state,and ZIP code) Nco II
Does applics 0 Ova/ — its- 9A ig District? Has this deduction been requested If yes,state atqio�nt of deduction
other county f on property for d
in Indiana? current year? III Yes ❑No Iip
A person is Dr Z1YC1 NO • ce on the person's mortgage or contract indebtedness that is recorded iin the county
recorder's a 'd in the county recorder's office)that is the basis for the deduction.
Card NO. :OUNTYAUDITOR
Deduction ai
20 20 20 20 20
Signature of Auditor,,.....,,,,,:e...4 County 'Date(m nth, a year)
to cl2o
I/We certify under the penalty of perjury thathove and foregoing information is true and correct and that the applicant s a r ident of Indiana-and
owner/contract buyer of the aforementioned property on date application is filed.
Signature full name) Date( onth, y,year)
Full re dent ess of ap li ant(num rand street,city, tale,an I code)•
. / mil , , , I Cfr410
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)
The nenalties for neriury can include imprisonment un to two and a half years and a fine not to exceed$10.000.